An Unusual Presentation of Disseminated Tuberculosis in South-West Nigeria: A Case Report

Martins Ehizode Emuze,Omolade O Adegoke,Chima Akunwata,John Akulue,Arinola Esan,Temitope E Ogunsanya,Oladotun Olalusi

doi:10.23937/2474-3658/1510236

Abstract

Disseminated tuberculosis is a leading cause of morbidity and mortality in developing nations. It could be a diagnostic challenge because of the nonspecific manifestations and sometimes atypical laboratory and radiologic findings. It results from haematogenous spread of <em>Mycobacterium tuberculosis</em> in 2 or more noncontiguous sites. Clinical features may include fever, weight loss, anorexia, anemia, pancytopenia, hepatosplenomegaly and most times, patients have elevated inflammatory markers like erythrocyte sedimentation rate (ESR). Delay in diagnosis and treatment could portend a poor clinical outcome for the patient. Therefore, a high index of suspicion is crucial for early diagnosis and management.

Highlights

Tuberculosis (TB) is a chronic infectious disease, principally caused by the bacillus, Mycobacterium tuberculosis (Mtb) [1]
We present a case of a 52-year-old man who presented with a 5-month history of fever, 3-month history of weight loss with 6-week history of body weakness
The World Health Organization (WHO) reported that approximately 10 million people were infected with Mtb in 2019; out of which about 1.2 million deaths occurred among human immunodeficiency virus (HIV)-negative people, with an estimated 208,000 deaths found to be related to HIVpositive individuals [2]

Summary

Introduction

Tuberculosis (TB) is a chronic infectious disease, principally caused by the bacillus, Mycobacterium tuberculosis (Mtb) [1]. We report a case of an adult male with unusual clinical manifestation of disseminated tuberculosis, who presented with fever, weight loss, anorexia, with hepatosplenomegaly, pancytopenia but normal ESR and Chest X-ray. There was no observed bleeding from body orifices or easy bruisability He reported an episode of passage of dark coloured stool about a week prior to presentation. The liver was enlarged, with a weight of 2050 g (Normal: 1200-1600 g) and section showed areas of nodular aggregates of necrotizing granulomas and steatosis (Figure 2). The cut surface of the left lung showed diffuse multiple tiny greyish white nodules with areas of oedema and congestion while examination of the right lung revealed congestion and oedema (Figure 4A and Figure 4B)

Findings

Discussion

Conclusion