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Case Reports
. 2018 Sep;11(9):42-46.
Epub 2018 Sep 1.

Extensive Multisystemic Disseminated Tuberculosis in an Immunocompetent Patient

Amrit Kaur  1   2   3 , Monika Kucheria  1   2   3 , Rekha Gupta  1   2   3 , Gurvinder Pal Thami  1   2   3 , Reetu Kundu  1   2   3
Affiliations
Case Reports

Extensive Multisystemic Disseminated Tuberculosis in an Immunocompetent Patient

Amrit Kaur et al. J Clin Aesthet Dermatol. 2018 Sep.

Abstract

Extrapulmonary tuberculosis is uncommon and has an insidious onset with slow evolution and a paucibacillary nature. Here, we present a case of disseminated tuberculosis in an adult immunocompetent man presenting with morphologically different types of cutaneous lesions (i.e., multiple subcutaneous abcesses and multiple noduloulcerative lesions with discharging sinuses with seropurulent fluid). Extensive screening in the form of routine blood investigations, serologies, skin biopsy, Montoux test, sputum examination, chest and skull roentgenogram, noncontrast computed tomography chest and abdomen, contrast-enhanced computed tomography of the skull, and magnetic resonance imaging of lumbosacral spine with screening of the whole spine revealed extensive involvement of the skin, subcutaneous tissue, lungs, lymph nodes, skull bone, mandible, ribs, scapula, pelvis and Pott's spine, and thyroid.

Keywords: Disseminated tuberculosis; immunocompetent; thyroid tuberculosis.

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Conflict of interest statement

FUNDING:No funding was provided for this study. DISCLOSURES:The authors have no conflicts of interest relevant to the content of this article.

Figures

FIGURE 1.
FIGURE 1.
Examination revealed multiple skin-colored, round-to-oval, ill-defined, diffuse, nontender, fluctuant swellings.
FIGURE 1.
FIGURE 1.
Examination revealed multiple skin-colored, round-to-oval, ill-defined, diffuse, nontender, fluctuant swellings.
FIGURE 2.
FIGURE 2.
Multiple erythematous plaques adherent to the underlying bone, puckered scars, and discharging sinuses were present over the scalp, forehead, right angle of the mandible, right midclavicular line, and feet.
FIGURE 2.
FIGURE 2.
Multiple erythematous plaques adherent to the underlying bone, puckered scars, and discharging sinuses were present over the scalp, forehead, right angle of the mandible, right midclavicular line, and feet.
FIGURE 3.
FIGURE 3.
A) Chest x-ray showed mild pleural effusion on the right side. X-ray of the skull and right mandible revealed multiple osteolytic lesions in the frontal and parietal bones and over the body of the mandible in relation to the root of the molars. B) Noncontrast computed tomography (CT) scans of the chest and abdomen showed multiple heterogeneously hypodense collections in the right axilla, left anterior abdominal wall, left posteroinferior chest wall, right psoas, and thyroid gland.
FIGURE 3.
FIGURE 3.
A) Chest x-ray showed mild pleural effusion on the right side. X-ray of the skull and right mandible revealed multiple osteolytic lesions in the frontal and parietal bones and over the body of the mandible in relation to the root of the molars. B) Noncontrast computed tomography (CT) scans of the chest and abdomen showed multiple heterogeneously hypodense collections in the right axilla, left anterior abdominal wall, left posteroinferior chest wall, right psoas, and thyroid gland.
FIGURE 4.
FIGURE 4.
Multifocal collections and lytic lesions observed on noncontrast computed tomography scans were confirmed by magnetic resonance imaging.
FIGURE 5.
FIGURE 5.
Ziehl-Neelsen stain and Periodic acid-Schiff stain were negative.
See this image and copyright information in PMC

References

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