Massive Disseminated Tuberculosis in an Immunocompetent Patient: Early Diagnostic and Empiric Treatment Approach from an Endemic Country: Indonesia (A Case Report and Literature Review)

Abstract

Tuberculosis is still rampant, despite the centuries of efforts to conquer it. Indonesia is host to the third highest TB burden in the world, with an uneven distribution of health care access, and especially to highly sensitive and specific molecular investigations. Rapid and accurate TB diagnosis is crucial for the control of the infection. An AFB smear test is easily accessed and is cost-effective, although there are a number of shortcomings with the approach. We report here on a case of negative acid-fast bacilli (AFB) smear disseminated tuberculosis (TB) in a previously healthy 23year-old Indonesian female who presented to a secondary care facility with pulmonary, pericardial, peritoneal, utero-ovarian, genitourinary and splenic involvement. The clinician chose to start antituberculosis therapy without a positive microbiology and biopsy for bacterial load containment purposes, considering also the patient's clinical and endemic epidemiology. The diagnosis was confirmed with a positive mycobacterial culture after the initiation of anti-tuberculosis therapy. In the present study, we also review the diagnosis of 20 other cases of disseminated tuberculosis reported in other countries.