Multifocal Tuberculosis in a Diabetic: An Atypical Manifestation

Abstract

Introduction: Multi-focal tuberculosis is an attack of two extra-pulmonary sites with or without pulmonary involvement. It is a rare pathology that is characterized by its large clinical and radiological polymorphism. We report the case of a 27-year-old patient with type 1 diabetes, who had had a stroke for 1 year. She reported the appearance of a sushyphoidal collection for a month. The clinical examination noted a sus-xyphoid collection firm edge and renit in its center of 5cm in diameter painless evoking a cold abscess. Examinations had shown poorly systematized opacity at the level of the right lung base on chest radiography, with the ultrasound of the upper xyphoidal region showing abscess collected supersternal with discontinuous sternal cortices, suggesting bone lysis. The CT scan confirmed the appearance of sternal osteitis with collections of the soft tissues opposite, multiple associated hepatic collections were objectified at the level of the abdominal sections with pulmonary involvement of infectious origin objectified to the thoracic sections. the puncture of the abscess had not found AFB. The diagnosis of multifocal tuberculosis was retained following a positive expert Gen test. Management consisted of anti- bacillary therapy, adjustment of insulin doses. The appearance of multi-focal tuberculosis is often misleading and can mislead the diagnosis. However, the essential thing is to know how to evoke them in order to be able to target the specific examinations and to engage the therapeutic strategy without delay. Our case illustrates an atypical manifestation of multifocal tuberculosis in a diabetic patient with pulmonary, cutaneous, hepatic and bone lesions of tuberculosis origin.