Disseminated tuberculosis in an immunocompetent healthy young male with nonspecific symptoms: challenges toward diagnosis-a case report

Abstract

Background: Disseminated tuberculosis, characterized by spread of Mycobacterium tuberculosis to multiple noncontiguous sites, is rare in immunocompetent individuals. Diagnosing disseminated tuberculosis is challenging due to its varied and often nonspecific symptoms.

Case presentation: We report the case of a 29-year-old Bangladeshi male with no notable past medical history, who presented with prolonged fever, night sweats, cough, weight loss, and altered bowel habits over 6 months. Initial evaluations in Italy and France did not yield a definitive diagnosis. Further investigations in Bangladesh, including sputum smear, fine-needle aspiration cytology of a postauricular lymph node, abdominal ultrasonography, and magnetic resonance imaging of the brain confirmed disseminated tuberculosis. The patient responded excellently to a standard four-drug antitubercular therapy regimen.

Conclusions: Disseminated tuberculosis should be considered in patients with systemic symptoms, particularly those from regions with a high tuberculosis burden. Early and accurate diagnosis, despite atypical presentations and initial negative findings, is crucial for effective treatment and improved outcomes.

Keywords: Case report; Diagnostic challenges; Disseminated tuberculosis; Persistent fever; Tuberculosis.

Fig. 1

Ultrasound image of the spleen showing multiple ill- and well-defined hypoechoic nodular lesions (A); Doppler image demonstrating a normal spleno-portal venous system (B)

Fig. 2

FNAC of left postauricular lymph node showing epithelioid cells and caseous necrosis

Fig. 3

MRI of the brain showing an infiltrative mass involving the left thalamus, midbrain, and adjacent medial occipito-temporal region (arrow) in axial T1-weighted image (A); contrast-enhanced image showing heterogeneous enhancement of the lesion (B)