Multifocal skeletal tuberculosis in an immunocompetent patient: a case report

Araújo, Paulo Sérgio Ramos de; Melo, Heloísa Ramos Lacerda de; Melo, Fábio Lopes de; Medeiros, Zulma; Maciel, Maria Amélia Vieira; Florêncio, Renata; Brandão, Eduardo

doi:10.1186/s12879-015-0985-x

Cited by 7 publications

(7 citation statements)

References 7 publications

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“…Joints that support greater weight loads, such as the knees and the hips, are the most affected in cases of skeletal tuberculosis [9]. Peripheral osteoarticular tuberculosis is the term used for extraspinal skeletal TB that affects joints or bones [10].…”

Section: Discussionmentioning

confidence: 99%

Disseminated Tuberculosis Presenting as Baker’s Cyst Infection

Pervin

Akram

Hudali

et al. 2017

Case Reports in Infectious Diseases

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Section: Discussionmentioning

confidence: 99%

Disseminated Tuberculosis Presenting as Baker’s Cyst Infection

Pervin

Akram

Hudali

et al. 2017

Case Reports in Infectious Diseases

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“…The same can be said about other forms of extrapulmonary TB. Though there are reports of breast TB [22], colonic TB [23], skeletal TB [24], and other forms of extrapulmonary TB in endemic countries, finding such reports in non-endemic countries is very rare. This suggests that contracting extrapulmonary TB increases in frequency in immunocompetent hosts that have been exposed to endemic areas (either immigrating from or traveling to these areas), but is still rare as compared to extrapulmonary TB in immunocompromised individuals.…”

Section: Discussionmentioning

confidence: 99%

Tuberculous Meningitis in an Immunocompetent Host: A Case Report

2016

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Patient: Male, 57Final Diagnosis: Tuberculous meningitisSymptoms: Altered mental state • headacheMedication: —Clinical Procedure: Lumbar punctureSpecialty: Infectious DiseasesObjective:Rare diseaseBackground:Tuberculous meningitis is very rare in the United States in immunocompetent hosts. Risk factors are similar to those of pulmonary tuberculosis, including poverty, malnutrition, overcrowding, a compromised immune system, and coming from an endemic area. Meningeal tuberculosis mortality and other outcomes have changed little over time despite effective therapies due to delay in diagnosis because of its rarity, variable presentation, and often indolent course.Case Report:We describe a case of a 57-year-old male immigrant from Senegal with no significant past medical history and no previous history of tuberculosis or evidence of immune compromise. He presented to the hospital with headache and altered mental status and was subsequently diagnosed with tuberculous meningitis.Conclusions:This is a rare case of tuberculous meningitis in an immunocompetent host, questioning the conventional view that tuberculous meningitis is a disease of immunocompromised individuals. It emphasizes the importance of maintaining a strong clinical suspicion of tuberculous meningitis even in an immunocompetent patient in a geographical area with low prevalence if the patient has risk factors. Missed or delayed diagnosis is commonly fatal.

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“…9 The TB that involves the posterior elements of the spine, particularly in isolation, is considered rare. According to literature, two hypotheses exist explaining this atypical presentation: [3][4][5] (1) Increased pressure in the body cavities leading to retrograde flow of blood and mycobacterium from a primary focus through the valveless Batson venous plexus located in the epidural space to the vertebral venous plexi. The posterior external venous plexi, which anastomose freely with the other vertebral venous plexi, could be a source of seeding of the mycobacterium to the posterior veins and posterior spinal structures by this mechanism and (2) infection of immunocompromised patients.…”

Section: Discussionmentioning

confidence: 99%

“…2 Multifocal skeletal involvement constitutes less than 5% of all bony TB even in countries where TB is endemic, and is rare in immunocompetent patients and in those with normal pulmonary findings. 4 These patients usually present with nonspecific symptoms and the disease usually presents with an indolent and atypical clinical course, usually leading to a delayed diagnosis along with significant bone and joint destruction. 5 The clinical and radiological manifestations in such cases may mimic other destructive bony lesions including malignancy.…”

Section: Introductionmentioning

confidence: 99%

Multifocal Skeletal Tuberculosis involving the Calvarium and Posterior Spinal Elements in an Immunocompetent Patient

Gotecha¹,

Chugh²,

Amle³

et al. 2017

The Journal of Spinal Surgery

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Tubercular osteomyelitis, a form of extrapulmonary tuberculosis (TB), represents less than 2% of all TB cases and about 10% of all cases of extrapulmonary TB. Isolated involvement of the posterior elements of the spine and calvarial TB are rare manifestations of extrapulmonary TB, especially in immunocompetent patients. We, hereby, present a case of a 12-year-old female patient with the mentioned multifocal skeletal involvement presenting with spastic paraparesis. Magnetic resonance imaging (MRI) of the cervicodorsal spine was suggestive of lesion involving the posterior elements of the spine from C7 to D3 vertebra with marrow edema and without involvement of the vertebral bodies and intervertebral discs. The MRI of the brain was suggestive of a lenticular-shaped extra-axial lesion in the right frontal region arising from inner table of calvaria. The patient was first operated for the lesion in the cervicodorsal spine due to acute-onset paraparesis followed by complete excision of frontal lobe lesion, which was done after 2 weeks of removing the spinal lesion. Histopathological examinations of both the lesions were suggestive of TB. Majority of patients with multifocal skeletal TB have nonspecific generalized somatic symptoms and signs at presentation and inconclusive radiological findings. All these factors can lead to a delay in diagnosis in such cases. Hence, a high index of suspicion for TB is necessary for patients presenting with multiple somatic symptoms and multiple destructive skeletal lesions, particularly in areas where TB is endemic.

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Multifocal skeletal tuberculosis in an immunocompetent patient: a case report

Cited by 7 publications

References 7 publications

Disseminated Tuberculosis Presenting as Baker’s Cyst Infection

Disseminated Tuberculosis Presenting as Baker’s Cyst Infection

Tuberculous Meningitis in an Immunocompetent Host: A Case Report

Multifocal Skeletal Tuberculosis involving the Calvarium and Posterior Spinal Elements in an Immunocompetent Patient

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