Form Of Extrapulmonary Tuberculosis Research Articles

Primary tuberculosis of appendix: A rare presentation

Gastrointestinal tuberculosis is a common form of extra pulmonary tuberculosis. Tuberculosis of the appendix is a rare variant of gastrointestinal tuberculosis even in countries where tuberculosis is endemic like India; however, it should be included as one of the differential diagnosis of appendicular swelling as its clinical presentation mimicking various other conditions e.g. acute on chronic appendicitis, appendicular malignancy or abscess. The majority of the previously reported cases of tubercular appendicitis had a primary focus elsewhere in the body. Here we are describing a case of isolated tuberculosis of the appendix, who underwent laparotomy with the suspicion of appendicitis. The diagnosis was confirmed by histopathological examination of the resected specimen. No primary focus was found in elsewhere in the body. He was treated with four drug anti-TB regimen (2HERZ+4HR) and was asymptomatic in full course of therapy and later also till six months of follow up. Apart from rarity due to primary involvement, this case report highlights the rare clinical presentation and significance of histopathology in the diagnosis of this uncommon entity. Keywords: Primary tubercular appendicitis, Histopathology, Anti-TB regimen

Extra-Pulmonary Tuberculosis: Retrospective Review of 83 Confirmed Cases, Observed in Radiology in Lomé (TOGO)

Background: Tuberculosis primarily affects lungs, but all organs may be affected. Extra-pulmonary forms of tuberculosis cause a big public health problem as it is diagnosed late. This delay in diagnosis is not only due to the delay in the examination, but also due to difficulties related to extra-pulmonary tuberculosis diagnostic. Aim: To describe the different locations of extra-pulmonary Tuberculosis and its aspects in Togo. Patients and Methods: A retrospective analysis of all extra-pulmonary tuberculosis cases diagnosed by imaging over five years (January 2010 to December 2015) was done. All the cases were confirmed either by direct examination of biological fluids or by histological analysis of biopsy and surgical samples or by culture on specific area. Data were collected from the Department of Radiology, from Microbiology Laboratory of the Pneumo-phthisiology unit and from Pathology Laboratory of Sylvanus Olympio Teaching Hospital of Lome. Results: A total of 83 cases of extra-pulmonary Tuberculosis had been taken into account: 45 men and 38 women, with a maximum number of cases (66.3%) in the age group between 20 to 40 years old. An HIV infection was known in 51 patients (61.4%). Pulmonary damage was associated in 21 patients (25.3%). A total of 116 extra-pulmonary tuberculosis locations were recorded. Damages were pleural in 37.1% (43), ganglion in 24.1% (28), osteo-articular in 15.5% (18), abdominal in 12.9% (15), military represented 8.6% (10), a case of testicular damage, and a case of mammary tuberculosis. Conclusion: The medical scanning based on conventional radiography, ultrasonography and TDM is indispensable for the diagnosis and the care taking of extra-pulmonary tuberculosis since some locations may be confused with many other diseases and lead to misdiagnosis errors and delay the treatment.

Frequency of tuberculosis in cervical lymphadenopathy

Background: Tuberculous lymphadenopathy is an important form of extrapulmonary tuberculosis. The role of fine needle aspiration cytology (FNAC) in the diagnosis of such lesions is a well-known fact. Objective: To study the incidence, utility, limitations of FNAC, and various cytomorphological presentations in reference to Ziehl–Neelsen staining in tuberculous lymphadenitis. Materials and Methods: A total 496 patients presenting with palpable cervical lymphadenopathies were referred to the cytology section of Pathology Department, Government Medical College, New Civil Hospital, Surat, Gujarat, India, over a period of 1 year (January to December 2014) were included in the study. The data entry was carried out using Microsoft Office Excel worksheet and analyzed. Result: Of the 496 lymph node aspirations, 277 (45.8%) cases were diagnosed as tuberculous lymphadenitis. The age of the patient ranged from 5 months to 65 years. The maximum number of cases 167 (73.6%) suggestive of the cytomorphology of tuberculous lymphadenitis were aged in the range of 11–30 years. There were 113 (49.7%) female and 114 (50.3%) male subjects. Male subjects showed a slight predominance for tuberculosis. In this study, the most common site of the involved lymph nodes was of the cervical region in 91.2% (227/249) cases. The caseating epithelioid granulomatous pattern of tubercular lymphadenitis was the most common cytomorphological pattern seen in 47.6% of patients in this study. Acid-fast bacilli (AFB) positivity was the maximum in necrotizing and suppurative lymphadenitis (44.7%). The highest AFB positivity for tubercle bacilli was found in the aspirates, which were purulent in gross appearance (42.8%). Conclusion: FNAC being a reliable, safe, rapid, and economical procedure is useful as an outdoor diagnostic procedure for the diagnosis of tubeculous lymphadenitis. From the cytomorphologic pattern and the AFB positivity, a rough estimate about the immune status can be made.

Surgical management of tuberculous constrictive pericarditis in a developing country: case report

Tuberculosis has been increasing in incidence in recent years especially in developing countries. Tuberculous pericarditis is a form of extra pulmonary tuberculosis that is considered unusual.

Pott's disease in Moroccan children: clinical features and investigation of the interleukin-12/interferon-γ pathway.

Tuberculosis spondylodiscitis (TS), or Pott's disease, an extra-pulmonary form of tuberculosis (TB), is rare and difficult to diagnose in children. Some cases of severe TB in children were recently explained by inborn errors of immunity affecting the interleukin-12/interferon-gamma (IL-12/IFN-γ) axis. To analyse clinical data on Moroccan children with TS, and to perform immunological and genetic explorations of the IL-12/IFN-γ axis. We studied nine children with TS diagnosed between 2012 and 2014. We investigated the IL-12/IFN-γ circuit by both whole-blood assays and sequencing of the coding regions of 14 core genes of this pathway. A diagnosis of TS was based on a combination of clinical, biological, histological and radiological data. QuantiFERON(®)-TB Gold In-Tube results were positive in 75% of patients. Whole-blood assays showed normal IL-12 and IFN-γ production in all but one patient, who displayed impaired decreased response to IL-12. No candidate disease-causing mutations were detected in the exonic regions of the 14 genes. TS diagnosis in children remains challenging, and is based largely on imaging. Further investigations of TS in children are required to determine the role of genetic defects in pathways that may or may not be related to the IL-12/IFN-γ axis.

Mycobacterium tuberculosis causing tuberculous lymphadenitis in Maputo, Mozambique.

BackgroundThe zoonosis bovine tuberculosis (TB) is known to be responsible for a considerable proportion of extrapulmonary TB. In Mozambique, bovine TB is a recognised problem in cattle, but little has been done to evaluate how Mycobacterium bovis has contributed to human TB. We here explore the public health risk for bovine TB in Maputo, by characterizing the isolates from tuberculous lymphadenitis (TBLN) cases, a common manifestation of bovine TB in humans, in the Pathology Service of Maputo Central Hospital, in Mozambique, during one year.ResultsAmong 110 patients suspected of having TBLN, 49 had a positive culture result. Of those, 48 (98 %) were positive for Mycobacterium tuberculosis complex and one for nontuberculous mycobacteria. Of the 45 isolates analysed by spoligotyping and Mycobacterial Interspersed Repetitive Unit – Variable Number Tandem Repeat (MIRU-VNTR), all were M. tuberculosis. No M. bovis was found.Cervical TBLN, corresponding to 39 (86.7 %) cases, was the main cause of TBLN and 66.7 % of those where from HIV positive patients.We found that TBLN in Maputo was caused by a variety of M. tuberculosis strains. The most prevalent lineage was the EAI (n = 19; 43.2 %). Particular common spoligotypes were SIT 48 (EAI1_SOM sublineage), SIT 42 (LAM 9), SIT 1 (Beijing) and SIT53 (T1), similar to findings among pulmonary cases.ConclusionsM. tuberculosis was the main etiological agent of TBLN in Maputo. M. tuberculosis genotypes were similar to the ones causing pulmonary TB, suggesting that in Maputo, cases of TBLN arise from the same source as pulmonary TB, rather than from an external zoonotic source. Further research is needed on other forms of extrapulmonary TB and in rural areas where there is high prevalence of bovine TB in cattle, to evaluate the risk of transmission of M. bovis from cattle to humans.Electronic supplementary materialThe online version of this article (doi:10.1186/s12866-015-0603-5) contains supplementary material, which is available to authorized users.

Pleural tuberculosis in a patient with untreated type 1 Gaucher disease

Gaucher disease (GD) is an autosomal recessive glycolipid storage disorder, due to deficiency of the lysosomal enzyme glucocerebrosidase, leading to accumulation of the substrate glucocerebroside in the cells of the macrophage-monocyte system. Patients with GD have alteration in their immune system and impaired microbicidal capacity of mononuclear phagocytes. It has also been demonstrated that monocyte dysfunction may correlate with the plasma glucocerebrosidase concentrations. Tuberculosis (TB) is a major public health problem in developing countries. Pleural TB is one of the most common forms of extra-pulmonary TB. Since immune system can be impaired due to the deficiency of glucocerebrosidase in various ways, TB can be observed in patients with GD especially when left untreated. Cytopenia(s) is also general finding in untreated Gaucher patients, and they may be observed most frequently due to the infiltration of the bone marrow with Gaucher cells together with the additional factor of splenomegaly. We herein present a case of an adult patient with heterozygous untreated GD1, who developed pleural TB complicated by ipsilateral pulmonary fibrosis. Before his admission to our clinic, pleurectomy operation was performed and 4-drug combination anti-TB therapy was initiated including isoniazid, rifampicin, ethambutol and pyrazinamide. Fever complaint was disappeared with anti-TB treatment but he also had fatigue and pain. After initiation of enzyme replacement therapy in addition to anti-TB treatment, clinical and hematological improvement was observed. To our knowledge, this is the first reported case of GD1 with pleural TB.

A Five Years Study of Tuberculous Meningitis in Iran.

Tuberculous meningitis (TBM) is a severe form of extra pulmonary tuberculosis with high mortality and morbidity rate in all age group patients specific in adults and children. The incidence and prevalence are not exactly known in Iran. In this study, we tried to evaluate the role of rapid diagnosis and to find out the highest risk group patients. Totally, 1783-suspected patients with tuberculous meningitis whose CSF specimens were admitted at Noor Pathobiology Laboratory, Tehran, Iran were enrolled in this study from January 2009 until December 2013. All specimens were checked for MTB by direct examination, culture and PCR tests, and for the adenosine deaminase (ADA). Confirmed positive cases were aged from 13 to 82 yr old with mean age 46.63 yr (SD±18.84). The number of diagnosed positive MTB was different by the 3 applied protocol, 64 by PCR, 28 by culture and 33 by direct examination. Considering the result of PCR protocol the TBM was approved in 64 patients with rate of 3.59%. Two patients had other infection as well, one 56 years old with VZV and the other patient who was HIV positive was 27 years old. Increased ADA titer higher than cutoff was relevant with other results of positive samples except in two cases. Analysis of the results proved adults are more at risk for tuberculous meningitis than children in Iran are. It is also confirmed PCR method provide the most efficient, rapid and reliable results for these patients who are at the critical situations.

Pulmonary tuberculosis with meningitis

We read with great interest the case report by GoicBarisic et al. [1] on “pulmonary tuberculosis with meningitis in a 7-month-old infant”. The case report provides an excellent overview of the pathogenesis and diagnosis of tuberculosis meningitis. It also rightly emphasizes the importance of screening and introducing chemoprophylaxis in infants exposed to patients with active tuberculosis as well as early discovery and therapy of the illness. We would like to share our views in this regard. Tuberculous meningitis though rare in Croatia, is seen commonly in developing countries like India. Other serious forms of extrapulmonary tuberculosis like spinal tuberculosis, abdominal tuberculosis are also frequently encountered. One of the reasons for this might be the increase in the number of human immunodeficiency virus cases, which causes decreased immunity and dissemination of tuberculosis to different parts of the body. Other factors contributing are overcrowding, delay in diagnosis and inadequate health facilities [2]. As per World Health Organization guidelines for treatment of tuberculous meningitis by Directly Observed Therapy Short Course, isoniazid, rifampin, pyrazinamide and streptomycin are given for 2 months followed by isoniazid and rifampicin for the next 4 months. Countries applying Directly Observed Thera-

Tubercular liver abscess: A rare presentation of a common disease

Tubercular liver abscess is one of the rarest forms of extra pulmonary tuberculosis. Despite high prevalence of tuberculosis in India hepatic involvement is rare. Here we present an interesting case of hepatic liver abscess with atypical presentation. Patient was managed successfully with anti tubercular therapy.

Epidemiology of extra pulmonary tuberculosis in Eastern Sudan

ObjectiveTo investigate the epidemiological factors associated with extra pulmonary tuberculosis (EPTB) in Kassala, Eastern Sudan. MethodsPatients infected with TB (pulmonary and extra-pulmonary) documented at the hospital were interviewed with a structured questionnaire used to gather socio-demographic information. The diagnosis of EPTB cases was based on presence of tuberculous granulomas in the histological samples, positive PCR to DNA of mycobacterium tuberculosis, radiological findings and fluid analysis suggestive of EPTB and clinical diagnosis with adequate response to anti-tuberculous therapy. ResultsA total of 985 patients with TB were enrolled in the study, including 761 (77.3%) with PTB and 224 (22.7%) with EPTB. The mean age (SD) of patients with PTB and EPTB was 33.2 (15.4) and 34.7 (14.6) years respectively. The prevalence of EPTB was at (22.7%), with TB lymphadenitis 79 (35.3%), marking the frequent form of EPTB followed by peritoneal TB 27 (12.05%). While residence and occupation were not associated with EPTB, those with lower level of education (OR = 0.3; confidence intervals (CI) = 0.2–0.5; P < 0.001), female (OR = 8.7, CI = 4.9–15.1, P < 0.001), non vaccination (OR = 70.3, CI = 34.2–144.3, P < 0.001), and non smoker (OR = 0.1; CI = 0.06–0.20; P < 0.001), were associated with high prevalence of EPTB. ConclusionsAround one quarter of patients with TB in this study were more likely to have EPTB. Therefore, effective strategic plans regarding diagnostic procedures and control measures are needed to reduce the burden of the disease in Sudan.

Exploring the sociodemographic and clinical features of extrapulmonary tuberculosis in Saudi Arabia.

BackgroundSaudi Arabia annually reports a relatively higher proportion (28–32%) of extrapulmonary tuberculosis (EPTB) cases in comparison to other global regions. However, there were few studies conducted so far to determine the sociodemographic factors and clinical manifestations associated with EPTB at a nationwide level.MethodologyA retrospective analysis on culture positive EPTB isolates collected from all the provinces of the country were conducted for a period of 12 months to determine the spectrum of diversity in EPTB infection sites and the confounding factors. A detailed clinical and demographical data analysis was carried out along with first line drug susceptibility testing.Principal FindingsIntra-thoracic and extra-thoracic lymph nodes (44.6%) were the most common sites of infection followed by gastrointestinal (17.3%) and central nervous systems (11.8%). Male patients were mostly infected (58.8%), in contrary to the global trend. Any drug resistance was observed in 23.1% isolates with a 2.1% of multi-drug resistance. HIV reactivity was found only in 2.2% cases. A higher proportion of Saudi nationals (58.8%) were infected compared to the immigrants, descending mostly from South Asia (34.4%) and South East Asia (31.2%). The Saudi population predominated with all forms of EPTB while immigrants showed no significant variations.ConclusionsSaudi Arabia faces a serious threat from EPTB, particularly to the central nervous system and gastrointestinal systems. More effective diagnostic strategies and control measures must be implemented to reduce the high rate of EPTB in the country. In addition, these findings warrant further detailed research to explore all related comorbid conditions of EPTB development, particularly the host-related factors.

To Assess the Burden of and Trends in Extra Pulmonary Tuberculosis at a Tertiary Care Hospital in India

Introduction: Extra pulmonary form of tuberculosis is an important public health disease which cannot be ignored because of its low transmissibility. Data on the exact burden of the disease in developing countries is scarce. Aim: To assess the burden of the disease in a tertiary care hospital of India. To study the clinical trends in the disease, and the utility of various diagnostic modalities for its diagnosis. To identify the Mycobacterial species and perform drug susceptibility test. Materials and Methods: A cross sectional study was carried out for a period of two years. A total of one hundred and forty seven samples were tested for extrapulmonary tuberculosis using a combination of bacteriological, cytological, histological and biochemical techniques to achieve proper diagnosis of the disease. Results: Young adults and females predominated in the study group and positive cases. Original Research Article Fatima et al.; BJMMR, 8(6): 495-502, 2015; Article no.BJMMR.2015.472 496 Microbiologically, 26% of the specimens were positive. Eighteen percent of them were found to be culture positive for M. tuberculosis. Smear by Ziehl Neelsen stain was positive in 9%. A combination of culture media both solid and liquid maximized the yield of Mycobacteria. Lymph node tuberculosis was found to be the predominant type followed by others. Fifteen percent of the strains were found to be resistant to the first line drugs used in treatment of tuberculosis. Cytology and biochemical findings were found to be less specific in diagnosis of extrapulmonary tuberculosis. Conclusion: Extrapulmonary form of tuberculosis is seen in significant number of the suspects. Hence, attention should be paid towards its proper and early diagnosis followed by rational management, as if neglected may lead to associated complications and sequalae.

Laboratory Diagnosis of Extra-pulmonary Tuberculosis (EPTB) in Resource-constrained Setting: State of the Art, Challenges and the Need.

During the last decade, remarkable progress has been made in the diagnostics of pulmonary tuberculosis; however, diagnostic challenges in extra-pulmonary tuberculosis (EPTB) remain to be addressed. Diagnosis of EPTB is difficult due to the pauci-bacillary nature of disease, the variable clinical presentation, and need for invasive procedures to secure appropriate sample, and lack of laboratory facilities in the resource-limited settings. A more accurate test to diagnose various forms of EPTB, which can easily be incorporated in the routine TB control programme, would contribute significantly towards improving EPTB case-detection and thus reducing the morbidity and mortality. In this overview, we describe the status of current conventional and newer methods available for laboratory diagnosis of EPTB and discuss the challenges in their implementation in the resource-limited settings, and suggestion for better EPTB diagnostic algorithms, which can be incorporated in the routine TB control programmes.

Tuberculosis at unusual sites: A case series from a tertiary care center in North Karnataka, India

Tuberculosis (TB) has long been a common and major public health problem in India. Pulmonary infection is the commonest form of the disease, though the bacteria can cause systemic infection in virtually any organ. The increased global incidence of acquired immune deficiency syndrome (AIDS) has led to a resurgence of TB, with reports of unusual sites being affected by the disease. Due to a very high incidence and prevalence of pulmonary TB in India, different forms of extrapulmonary TB are also relatively high. It can present in many diverse ways at unusual sites, which can be confused with many treatable and nontreatable conditions. Here, we present a case series of primary and secondary forms of TB at unusual sites.

Prospective Analysis of 55 Cases of Tuberculosis Meningitis (TBM) in North India.

To assess the clinical profile, laboratory and neuroimaging data of adult tuberculous meningitis (TBM) patients and to determine the predictors of mortality. A total of 55 TBM patients and 60 controls were enrolled in this prospective study. Detailed clinical, radiological, biochemical and microbiological evaluation was performed. Done using SPSS 15.0 for Windows. P value of <0.05 was considered to be significant. 61.8% were males and majority of the study subjects belonged to age group of 21-40 years. Duration of symptoms in all cases was >14 days and commonly included fever, headache, neck rigidity, altered sensorium and vomiting. Biochemical features of cerebrospinal fluid (CSF) showed significant results where 94.5%, 85.45%,83.63% and 81.81% of patients showed CSF sugar levels <2/3 corresponding blood sugar, proteins>100mg%, CSF total leucocyte count of >20 cells/mm(3) and ADA >9.5IU/L respectively while neuroimaging revealed hydrocephalus, basal exudates and meningeal enhancement as significant findings. More than half of TBM patients presented in stage II of disease and overall mortality was 43.63%. A model for prediction of mortality in TBM cases was framed which included variables of age>40 years, past history of tuberculosis (TB), presence of basal exudates and hydrocephalus. TBM is a serious extrapulmonary form of TB and should arise suspicion in mind of clinician based on clinical, laboratory and radiologic results. Further, a model for prediction of mortality in such patients may be helpful for early intervention and better prognosis.

Multidrug-resistant tubercular cold abscess: a rare form of extrapulmonary MDR-TB

Although prevalence of drug-resistant pulmonary tuberculosis is increasing globally, only a few cases of drug-resistant extrapulmonary tuberculosis have been reported globally so far. Tubercular cold abscess is a form of extrapulmonary tuberculosis that is responsible for a significant morbidity and mortality. It is more challenging to the patient and clinician if the same occur due to multidrug-resistant strain of Mycobacterium. We report a case of multidrug-resistant tubercular cold abscess that is extremely rare in the literature.

Multiplex Analysis of Pro- or Anti-Inflammatory Serum Cytokines and Chemokines in relation to Gender and Age among Tanzanian Tuberculous Lymphadenitis Patients.

Objectives. Tuberculous lymphadenitis is the most common form of extrapulmonary tuberculosis (TB) with a female and paediatric preponderance, postulated to be due to differences in the immune response. The aim of this study was to analyze the differences in the serum cytokine levels of tuberculous lymphadenitis patients with respect to age and gender. Methods. A multiplex bead-based enzyme-linked immunosorbent assay was used to measure IFN-γ, TNF-α, GM-CSF, IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IL-15, and IL-17 levels in sera of patients (n = 86) and healthy controls (n = 23). Results. Levels of IFN-γ, TNF-α, GM-CSF, IL-1β, IL-2, IL-4, and IL-6 were higher in adult patients than in controls, while those of IL-12 were lower (P < 0.05). Children had lower levels of TNF-α, GM-CSF, and IL-5 and higher levels of IL-2 compared with adult patients (P < 0.05). The male adult patients had higher levels of IL-17 and lower levels of IL-12 compared with female adult patients (P < 0.05). Conclusion. There were significant differences in the levels of circulating cytokines with respect to gender and age. Children had generally lower levels of cytokines as compared to adults, which could make them more susceptible. Findings do not support that female preponderance is due to differences in immune response.

Perfil Epidemiológico dos casos de Tuberculose Extrapulmonar em um município do estado da Paraíba, 2001-2010

INTRODUÇÃO: A forma extrapulmonar da tuberculose é aquela em que há comprometimento de outros órgãos diferentes do pulmão.OBJETIVO: Identificar o perfil dos casos de tuberculose extrapulmonar notificados no município de Campina Grande (PB) no período de 2001 a 2010.MÉTODO: Trata-se de um estudo retrospectivo, transversal com abordagem quantitativa. Os dados foram submetidos ao cálculo de frequências absolutas e relativas, incidências e aplicação do teste χ2 para associação.RESULTADOS: A incidência média foi de 5,3/100.000 habitantes. O perfil evidenciou sexo masculino (52,8%), idade entre 20 e 39 anos (48,4%), raça branca (44,4%) e com ensino fundamental incompleto (39,3%), houve forte associação entre indicação ao Tratamento Supervisionado e as variáveis escolaridade, realização do teste anti-HIV e presença de AIDS, sendo o acometimento pleural e ganglionar periférico os de maior prevalência entre os casos.CONCLUSÃO: Conhecer o perfil e as características clínico-epidemiológicas da tuberculose extrapulmonar se faz importante, pois pode auxiliar os serviços de saúde na identificação e acompanhamento da população com maior vulnerabilidade para o adoecimento. Tendo em vista a gravidade das lesões e possível evolução ao óbito, esta deve ser diagnosticada e tratada o mais brevemente possível.

Prolonged febrile syndrome. What could we find?

Background Often a patient with prolonged fever requires a complex medical approach involving several medical specialties and extensive laboratory investigations. Case report We report the case of a 32 year male who presented for prolonged febrile syndrome about 2 months, chills and discreet urinary symptoms, initially interpreted to be a chronic prostatitis and treated for about 40 days with fluoroquinolones. His medical history included myasthenia gravis with immunosuppressive treatment and thymectomy. Physical examination revealed patient with fever especially at night, a tumor of 10/5 cm in the right coxofemoral joint region, right testicular swelling, difficulty in urinating. The biological findings showed lymphopenia, CD4 = 64 cells/cmm, a marker of sepsis positive, incomplete cholestatic syndrome, urinalysis with leukocytes and erythrocytes, negative urine culture, blood cultures were negative. Genitourinary ultrasound and urography were performed, which found enlarged epididymis with multiple nodules, heterogeneous prostate. Polymerase chain reaction from urinary sediment was positive for Mycobaterium tuberculosis. Given the results of the investigations, urinary tuberculosis was suspected and anti-tuberculous (TB) treatment was initiated while waiting for the culture results. Patient’s clinical status worsened, with the persistence of fever and chills, and the increase of tumor growth in the right coxofemoral joint region. The soft tissue ultrasound showed fluid collection along the psoas muscle straight to the scrotal region. Following surgery the fluid collection from right coxofemoral joint region was drained while the patient continued TB therapy with fever remission. Conclusion In our country tuberculosis is a real public health problem, especially in immunocompromised patients. In literature, extrapulmonary tuberculosis such as genitourinary TB is noted as the second most common form of extrapulmonary TB in countries with increased incidence of tuberculosis. However there are no multicenter studies with a high level of evidence on this problem.