Manifestation Of Tuberculosis Research Articles

Tuberculous Paraplegia: Outcome of Operative Intervention.

Tuberculosis of the spine, a common manifestation of extra-pulmonary tuberculosis is characterized by vertebral destruction, paradiscal involvement, abscess collection and varying degrees of neurologic affectation. The primary disease caused by mycobacterium tuberculosis complex infects the lungs, lymph nodes of the mediastinum and gastrointestinal tract/ viscera with spinal involvement being secondary and caused by haematogenous spread. Tuberculous paraplegia arises as a complication of spinal involvement. To determine the outcome of operative intervention in tuberculous paraplegia. Methodology: This was a retrospective study involving 10 patients with tuberculous spinal involvement with varying degrees of neurological deficit as defined by both Tuli and ASIA grading. The VAS score, ESR, ASIA grade (both pre-op and post op), Tuli's grade (pre-op and post op) were used to analyze the therapeutic effects of the surgery. The mean pre-operative VAS score was 5.9 ±1.8, which significantly decreased to 2.2 ±1.3 six weeks post operatively. The mean pre-operative ESR and CRP was 78.9 ± 11.3mm/hr and 83 ± 13.5 respectively; which both showed a statistically significant decrease post-operatively, p<0.05. All cases achieved an increase of more than one ASIA grade post-operatively. Early surgical intervention is beneficial in patients with tuberculous spinal disease with neurologic involvement.

Pediatric tuberculosis in Mexico: A retrospective analysis of 100 patients

BackgroundAnalyzing the epidemiology and clinical manifestations of pediatric tuberculosis in endemic regions is crucial to meet the goal of ending tuberculosis. The objective was to assess the various clinical scenarios of tuberculosis in a large pediatric cohort in Mexico. MethodsThis retrospective study from a pediatric referral center in Mexico included patients diagnosed with tuberculosis from 2012 to 2021. We analyzed clinical data and diagnostic study results, including demographic characteristics, underlying medical conditions, BCG vaccination, clinical presentation, imaging findings, microbiologic data, treatment, and clinical outcomes. Basic descriptive statistics and Chi-squared analysis were performed to summarize the metadata of pediatric patients with different clinical presentations of tuberculosis and evaluate their association with mortality, respectively. ResultsA total of 100 patients were included with a mean age of 7.76 years ± 1.49 years. The most prevalent clinical presentation was pulmonary tuberculosis (n = 51). Only 51 patients were immunized with Bacillus Calmette–Guérin vaccine. The most commons symptoms were fever, cough and weight loss. Among patients with meningeal tuberculosis (n = 14), the most common clinical signs were seizures, fever, and vomiting. Cure was achieved in 52 patients, 12 patients died, and 36 continue in treatment. Clinical presentation of tuberculosis (p-value = 0.009) and immunodeficiency (p-value = 0.015) were significantly associated with mortality. ConclusionsIncreasing the visibility of tuberculosis is imperative to end this disease. We report relevant clinical data of a large pediatric tuberculosis cohort, stratified by the different forms of disease. A high index of suspicion of tuberculosis is required for a timely diagnosis and treatment initiation, particularly among immunocompromised individuals, in whom mortality is higher.

The effects of IL-27 and IL-35 gene variation and expression levels on the susceptibility and clinical manifestations of pulmonary tuberculosis.

Inflammatory cytokines have crucial roles in the pathogenesis of tuberculosis (TB), and interleukin (IL)-27 and IL-35 have a pro-inflammatory and anti-inflammatory effect on many diseases, including infectious diseases. Therefore, we evaluated the relationship between IL-27 and IL-35 gene polymorphism, expression levels, and pulmonary TB (PTB) susceptibility. Nine single-nucleotide polymorphisms (SNPs) in the IL-27 gene (rs181206, rs153109, and rs17855750) and the IL-35 gene (rs4740, rs428253, rs9807813, rs2243123, rs2243135, and rs568408) were genotyped by the SNPscan technique in 497 patients with PTB and 501 controls. There was no significant difference regarding the genotype and allele frequencies of the above SNPs in the IL-27 and IL-35 genes between patients with PTB and controls. Haplotype analysis showed that the frequency of the GAC haplotype in the IL-35 gene was significantly decreased in patients with PTB when compared to controls (p = 0.036). Stratified analysis suggested that the frequency of the IL-27 rs17855750 GG genotype was significantly increased in patients with PTB with fever. Moreover, the lower frequency of the IL-35 rs568408 GA genotype was associated with drug-induced liver injury in patients with PTB. The IL-35 rs428253 GC genotype, as well as the rs4740 AA genotype and A allele, showed significant relationships with hypoproteinemia in patients with PTB. When compared with controls, the IL-27 level was significantly increased in patients with PTB. Taken together, IL-35 gene variation might contribute to a protective role on the susceptibility to PTB, and IL-27 and IL-35 gene polymorphisms were associated with several clinical manifestations of patients with PTB.

Cerebral Tuberculomas Mimicking A Brain Tumor: Report of Two Cases

Introduction : Cerebral tuberculoma, a seldom encountered and severe manifestation of tuberculosis (TB), arises from the dissemination of Mycobacterium tuberculosis through the bloodstream. Its symptoms and radiological characteristics lack specificity, often resulting in diagnostic errors. Management predominantly involves medical intervention, with the treatment duration for cerebral tuberculoma ranging from 6 to 36 months. In specific instances, surgical intervention may be advised. Case presentation: We reported two cases of cerebral tuberculoma occurring in patients who presented with seizures, with space-occupying lesions evident on magnetic resonance imaging of the brain. There were no symptoms of concurrent extra cranial TB. Surgery was performed on both of the cases and anti-TB treatment began as soon as the diagnosis was made with corticosteroid as adjuvant treatment. Conclusion: : A combination of clinical, radiological, and histopathological examination is needed to confirm the diagnosis and determine the appropriate therapy. If ICP is increased as a result of the lesion and medical therapy has failed, surgical excision is required.

Comments and Illustrations of Ultrasound Findings in Extrapulmonary Tuberculosis Manifestations.

This review describes the appearance of extrapulmonary tuberculosis manifestations in comprehensive and multiparametric ultrasound imaging. The aim is to increase awareness of typical ultrasound findings regarding extrapulmonary tuberculosis, correlate those with pathological features, and facilitate differential diagnosis. Point of care ultrasound protocols can be used as a screening method in high-risk populations, although the negative findings do not exclude tuberculosis. Conversely, the diagnosis of extrapulmonary tuberculosis can never be made using ultrasound alone, as many ultrasound findings in extrapulmonary tuberculosis are non-specific. However, ultrasound-based sampling techniques can significantly facilitate the collection of samples for microbiological or molecular proof of tuberculosis, as well as facilitating the establishment of alternative diagnoses.

Oral and Maxillofacial Manifestations of Tuberculosis Presented to Primary Health Care Centres in Port Sudan, Sudan

Tuberculosis is a chronic granulomatous disease caused by various strains of mycobacteria, usually Mycobacterium Tuberculosis in humans. Robert Koch, a German physician, discovered the Tuberculosis bacillus in 1882 [1]. It has been a worldwide major health problem for centuries. Although the disease’s prevalence reduced decades ago, it still has extremely high prevalence in Asian and African countries. It may take any form clinically, but with decline in number, these tuberculosis lesions of oral cavity have become so rare that they are frequently overlooked in the differential diagnosis of oral lesions. Although, oral manifestations of tuberculosis has a rare occurrence, but it has been considered to account for 0.1-5% of all TB infections.

Novel role of cardiovascular MRI to contextualise tuberculous pericardial inflammation and oedema as predictors of constrictive pericarditis.

Tuberculosis (TB) and human immunodeficiency virus/acquired immunodeficiency syndrome have reached epidemic proportions, particularly affecting vulnerable populations in low- and middle-income countries of sub-Saharan Africa. TB pericarditis is the commonest cardiac manifestation of TB and is the leading cause of constrictive pericarditis, a reversible (by surgical pericardiectomy) cause of diastolic heart failure in endemic areas. Unpacking the complex mechanisms underpinning constrictive haemodynamics in TB pericarditis has proven challenging, leaving various basic and clinical research questions unanswered. Subsequently, risk stratification strategies for constrictive outcomes have remained unsatisfactory. Unique pericardial tissue characteristics, as identified on cardiovascular magnetic resonance imaging, enable us to stage and quantify pericardial inflammation and may assist in identifying patients at higher risk of tissue remodelling and pericardial constriction, as well as predict the degree of disease reversibility, tailor medical therapy, and determine the ideal timing for surgical pericardiectomy.

Concomitant Tuberculous and Lepromatous Lymphadenitis: Clues and Pitfalls of Leprosy Concealed by Tuberculosis in Lymph Nodes.

Comorbidities between tuberculosis and leprosy are expected in endemic regions. Pulmonary tuberculosis and cutaneous leprosy are the most prevalent coinfections. One of the common manifestations of tuberculosis is generalized lymphadenopathy. In contrast, leprosy is clinically less suspected to manifest as a generalized lymphadenopathy, and it is pathologically unusual to diagnose leprosy primarily in lymph nodes. Concomitant tuberculous and lepromatous lymphadenitis are unprecedented and clinically unexpected, particularly in nonendemic countries. This imposes diagnostic challenges. We report concurrent tuberculosis and leprosy that were diagnosed in a lymph node in 45-year-old man with generalized lymphadenopathy. The effaced lymph node was predominantly replaced by caseating epithelioid granulomas alternating with foamy histiocytes. Ziehl-Neelsen stain showed positive acid-fast bacilli in the necrotizing granulomas only. The initial differential diagnosis of the nodal foamy macrophages included fungal infections, leishmaniasis, and Whipple disease, for which the special stains were negative. The vacuolated macrophages were disregarded as nonspecific lipogranuloma. A modified acid-fast stain was not considered. The histopathologic clues to nodal lepromatous leprosy included the presence of intracytoplasmic globi, intermixed microabscesses, and lymphoplasmacytic infiltrate and involved pericapsular nerves. Wade-Fite stain was subsequently performed. It revealed numerous lepra bacilli within the foamy histiocytes. The final diagnosis was concurrent disseminated tuberculosis and leprosy. Nodal lepromatous leprosy could be missed when compounded by concurrent nodal tuberculosis, particularly in developed countries. The clinicians and pathologists should have a high index of suspicion, particularly in patients from or with history of travel from endemic regions. Certain histopathologic features are helpful clues to avoid pitfalls.

Bilateral Endoscopic Debridement Combined with Local Antituberculosis Drugs for Thoracic Tuberculosis with Large Paravertebral Abscess: A Multicenter Study with 4-year Follow-Up

BackgroundParavertebral abscess represents a prevalent manifestation of thoracic tuberculosis, often necessitating surgical intervention. In this study, we introduced a novel approach by employing bilateral endoscopic debridement to address large Paravertebral abscesses associated with thoracic tuberculosis, a method not previously proposed in the literature. The clinical efficacy was examined through a comprehensive 4-year follow-up. MethodsWe conducted a retrospective analysis on patients diagnosed with thoracic tuberculosis and paravertebral abscess (TB-PA) who underwent bilateral endoscopic debridement combined with local antituberculosis drugs (BED+LAD) between February 2015 and February 2019. A total of 29 eligible patients (12 males and 17 females) with a median (interquartile ranges, IQR) of 59.0(16.5) years were included in the study. All patients received the BED+LAD treatment. After the surgery, the patients were treated with a 4-drug antituberculosis therapy (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol). All relevant indicators were meticulously recorded and analyzed. ResultsThe surgical procedures were successfully completed for all subjects, with an average intraoperative bleeding volume of (25.2 ± 8.9) ml, an average surgical time of (68.4 ± 14.0) minutes, an average fluoroscopy frequency of (21.7 ± 8.2) times, an average hospital stay of (14.2 ± 4.3) days, and an average medication period of (42.1 ± 9.6) weeks. All subjects completed at least a 4-year follow-up period. At the final follow-up, ESR and CRP levels returned to normal, and there was no significant increase in the Cobb angle (P>0.05). ConclusionThe application of BED+LAD in the treatment of TB-PA proved to be a safe, effective, and feasible approach.

Neuroimaging of tuberculosis- modalities, imaging protocols and radiomics: a review

Background and Objective:&#x0D; A large number of review and research articles exists in literature which describe the radiological appearance of various manifestations of nervous system tuberculosis, however there is paucity of text which describes the application of each and every imaging modality in the workup of the entire spectrum of this pathology. The intent of this article is to review the existing literature on the role of different radiological modalities in the stepwise work up of CNS TB. The article focuses on the role of plain radiograph, fluoroscopy, computed tomography, magnetic resonance imaging along with its advanced sequences and nuclear medicine in imaging of the many faces of tuberculosis in CNS. The article also aims to review the existing literature on the role of MR based textural analysis (Radiomics) as a problem-solving tool in various nervous system pathologies.&#x0D; Methods:&#x0D; We searched PubMed central databases for articles published in English from January 1 2000 to February 28 2021 along with references from the relevant articles. The search terms included “imaging in central nervous system tuberculosis” “Radiomics in tuberculosis “, “Radomics in central nervous system ”. In total 95 articles including case reports, case series, original articles and review articles were included in this review.&#x0D; Results:&#x0D; Conventional imaging modalities including radiograph and fluoroscopy are becoming extinct in work up of tuberculosis in the nervous system itself, however a plain radiograph still holds a key position in screening the chest for presence of subclinical respiratory tract infection in patients presenting with brain tuberculosis. In addition, it is a sensitive tool as baseline investigation in workup of spinal tuberculosis (T.B). Fluoroscopy is a useful tool in image guided procedures for collection of samples for histopathology and CSF analysis.&#x0D; Cross sectional imaging modalities including computed tomography and magnetic resonance imaging have revolutionized imaging of central nervous system pathologies in particular tuberculosis. Computed tomography acts as a screening tool to identify the presence of intracranial tuberculosis and recognize its complications. In addition it is an important tool to determine the extent of spinal T.B. Magnetic Resonance Imaging (MRI) along with its advanced sequences including spectroscopy, Magnetization transfer T1 sequence (MT T1), perfusion imaging, and magnetic resonance angiography (MRA) and magnetic resonance venography (MRV) is an ideal imaging method to work up CNS TB. It can identify numerous manifestations of tuberculosis in the brain, work up its associated complication, and explain the extent of neurological symptoms. Moreover, it has the capability to differentiate TB from other nervous system infections. Furthermore, it can differentiate neoplastic and inflammatory brain disorders from CNS TB. Radiomics, particularly the textural features based on MR imaging is the future of neuroimaging. Its role is getting established in the work up of several intracranial pathologies including brain tumors and neurodegenerative disorders. Certainly, it has significant potential in the imaging work up of CNS tuberculosis, which is underexplored and therefore requires the central attention of upcoming researchers focusing on this topic.&#x0D; Conclusion:&#x0D; Cross sectional imaging is the mainstay of imaging workup. Nuclear imaging is becoming an essential adjuvant to determine the burden of the disease. Role of radiomics is evolving in intracranial pathologies and certainly needs the central attention of future researches to establish its role in CNS TB imaging.

Think TB! A rare case of influenza and rapid progressive neurotuberculosis coinfection

An Indian migrant presented with increasing neurological symptoms after an acute influenza B infection. We diagnosed progressive neurotuberculosis—a rare and difficult case of tuberculosis and influenza co-infection. It highlights the importance of broad-based diagnostics in people from low- and middle-income countries, taking into account unusual manifestations of tuberculosis.

An unusual case of primary tuberculosis of the patella and patellar tendon masquerading as gout.

Tuberculosis (TB), an infection caused by Mycobacterium tuberculosis, accounts for significant morbidity and mortality worldwide. While primary TB predominantly involves the respiratory system, approximately 10-19% patients have musculoskeletal involvement. We present a case of a 54-year-old year gentleman with insidious onset of anterior knee pain. Imaging demonstrated a soft tissue lesion involving the patellar tendon and eroding the inferior pole of the patella. The imaging features, particularly ultrasound, resembled those that are typically seen with gout. Ultrasound guided biopsy revealed this to be TB of the patella. The patient was successfully treated with antitubercular therapy. Musculoskeletal TB, while usually not a primary form of TB, is an important consideration particularly in patients with risk factors for the disease. Its imaging features can mimic other forms of arthropathy such as gout. Moreover, while the knee is a relatively common site for TB infection, isolated involvement of the patella and patellar tendon is extremely rare. The case highlights the possibility of rare musculoskeletal manifestation of TB as a well as a potential imaging pitfall of TB infection mimicking gout, which is an important consideration in clinical practice.

The Usefulness of Dramatics for Teaching Cutaneous Tuberculosis: An Edutainment Approach for Postgraduate Medical Students.

About 1.5% of tuberculosis manifestations is cutaneous and accounts for 0.1-0.9% of total OPD patients in India. Forty first-year postgraduate medical students were taught cutaneous TB though conventional PPT, 'Carousel Role Play' and 'Theatre of the Oppressed' technique. The statistically significant effectiveness of theatrical workshops was noted.

Osteoarticular tuberculosis in infants: A diagnostic and management challenge

Objectives: Musculoskeletal manifestations of tuberculosis in infants are rare and different both in etiopathological mechanism and clinical presentation. Radiological diagnosis of osteoarticular tuberculosis (TB) in infants is tricky due to the various differentials of a cystic lesion. Literature also mention it only in isolated case reports. We carried out this study with an aim to collate and study patterns of osteoarticlular TB in the appendicular skeleton and to highlight the difficulties in diagnosis and management. Material and Methods: We retrospectively reviewed the data at our hospital over the past 8 years. Microbiologically confirmed osteoarticular tuberculosis affecting appendicular skeleton in children below 1 year of age were included in the study. Cases with spine involvement were excluded. The delay to diagnosis from the onset of symptoms, the initial diagnosis and treatment given were noted. The resolution of radiological presentation and occurrence of deformities at the final follow up (atleast 1 year) were noted. Results: During the study period, 8 infants were diagnosed to have osteoarticular tuberculosis with median age at presentation of 8.7 months (range 3 to 12 months). Average duration of follow up was 4 years (range 1 to 8 years). Cystic, Erosive, infiltrative, spina ventosa and mortar pestle were the radiological appearances found. Three of the 8 cases were referred as suspected malignancy. All but one case were vaccinated with BCG. Curettage and anti-tubercular therapy (ATT) were the treatment in all cases. Three cases with a delay in diagnosis of more than 2 months, developed complications: 1 had limb length discrepancy (LLD) due to physeal involvement, 1 developed angular deformity and 1 child had perthe’s disease as a sequelae. Conclusion: Osteoarticular tuberculosis is an increasing possibility, shockingly, even in infancy and should be a differential in an endemic country like India. A delay to diagnosis of even 2 months of this condition can lead to devastating complications. Being mindful of the diagnosis and early treatment gives rewarding results.

PERITONEAL TUBERCULOSIS MIMIKING GASTROINTESTINAL STROMAL TUMOR

Abdominal TB is a common site of extrapulmonary tubercilosis, and peritoneal tuberculosis (PTB) is one of the most common manifestations of abdominal tuberculosis. The diagnosis of PTB can be made based on a combination of clinical, radiological, histological, and laboratory tests. The diagnosis can be easy in the presence of ascites with peritoneal granulations. some forms of PTB can make a differential diagnosis with peritoneal or digestive tract pathologies. some forms of PTB can make a differential diagnosis with peritoneal or digestive tract pathologies. We report a case of primary mesenteric tuberculosis mimicking gastrointestinal stromal tumor. The final diagnostic was performed using a combination of invasive and imaging techniques.

Radiographic characteristics of rifampicin-resistant tuberculosis in the STREAM stage 1 trial and their influence on time to culture conversion in the short regimen

BackgroundStage 1 of the STREAM trial demonstrated that the 9 month (Short) regimen developed in Bangladesh was non-inferior to the 20 month (Long) 2011 World Health Organization recommended regimen. We assess the association between HIV infection and radiographic manifestations of tuberculosis and factors associated with time to culture conversion in Stage 1 of the STREAM trial.MethodsReading of chest radiographs was undertaken independently by two clinicians, and films with discordant reading were read by a third reader. Recording of abnormal opacity of the lung parenchyma included location (right upper, right lower, left upper, and left lower) and extent of disease (minimal, moderately-advanced, and far advanced). Time to culture conversion was defined as the number of days from initiation of treatment to the first of two consecutive negative culture results, and compared using the log-rank test, stratified by country. Cox proportional hazards models, stratified by country and adjusted for HIV status, were used to identify factors associated with culture conversion.ResultsOf the 364 participants, all but one had an abnormal chest X-ray: 347 (95%) had opacities over upper lung fields, 318 (87%) had opacities over lower lung fields, 124 (34%) had far advanced pulmonary involvement, and 281 (77%) had cavitation. There was no significant association between HIV and locations of lung parenchymal opacities, extent of opacities, the presence of cavitation, and location of cavitation. Participants infected with HIV were significantly less likely to have the highest positivity grade (3+) of sputum culture (p = 0.035) as compared to participants not infected with HIV. Cavitation was significantly associated with high smear positivity grades (p < 0.001) and high culture positivity grades (p = 0.004) among all participants. Co-infection with HIV was associated with a shorter time to culture conversion (hazard ratio 1.59, 95% CI 1.05–2.40).ConclusionsRadiographic manifestations of tuberculosis among the HIV-infected in the era of anti-retroviral therapy may not differ from that among those who were not infected with HIV. Radiographic manifestations were not consistently associated with time to culture conversion, perhaps indicating that the Short regimen is sufficiently powerful in achieving sputum conversion across the spectrum of radiographic pulmonary involvements.Trial registrationISRCTN ISRCTN78372190. Registered 14/10/2010. The date of first registration 10/02/2016.

Recent Advances in Nanotechnology-Based Strategies for Bone Tuberculosis Management.

Bone tuberculosis, an extrapulmonary manifestation of tuberculosis, presents unique treatment challenges, including its insidious onset and complex pathology. While advancements in anti-tubercular therapy have been made, the efficacy is often limited by difficulties in achieving targeted drug concentrations and avoiding systemic toxicity. The intricate bone structure and presence of granulomas further impede effective drug delivery. Nano-drug delivery systems have emerged as a promising alternative, offering the enhanced targeting of anti-tubercular drugs. These systems, characterized by their minute size and adaptable surface properties, can be tailored to improve drug solubility, stability, and bioavailability, while also responding to specific stimuli within the bone TB microenvironment for controlled drug release. Nano-drug delivery systems can encapsulate drugs for precise delivery to the infection site. A significant innovation is their integration with prosthetics or biomaterials, which aids in both drug delivery and bone reconstruction, addressing the infection and its osteological consequences. This review provides a comprehensive overview of the pathophysiology of bone tuberculosis and its current treatments, emphasizing their limitations. It then delves into the advancements in nano-drug delivery systems, discussing their design, functionality, and role in bone TB therapy. The review assesses their potential in preclinical research, particularly in targeted drug delivery, treatment efficacy, and a reduction of side effects. Finally, it highlights the transformative promise of nanotechnology in bone TB treatments and suggests future research directions in this evolving field.

Kiosk 5Q-FA-04 - Looking for Zebras: Constrictive Pericarditis as a Manifestation of tuberculosis

Kiosk 5Q-FA-04 - Looking for Zebras: Constrictive Pericarditis as a Manifestation of tuberculosis

A case report on new-onset peritoneal tuberculosis in ankylosing spondylitis patient on adalimumab

Adalimumab, a widely employed tumor necrosis factor-alpha inhibitor for autoimmune diseases, raises concern about reactivating latent tuberculosis (TB) and new-onset TB. Despite its established efficacy in managing inflammation, clinicians must recognize and manage adalimumab-induced TB promptly to minimize associated morbidity. This case report explores guidelines for TB screening in adalimumab-treated patients, utilizing interferon-gamma release assays and tuberculin skin tests, and discusses treatment considerations. Increased TB incidence in adalimumab-treated patients necessitates vigilant screening for latent TB before therapy initiation. Therapeutic decisions must balance the need for continuing immunosuppressive therapy against the potential risks of uncontrolled TB. Diagnostic challenges arise from atypical presentations and the intricate interplay between adalimumab therapy and TB manifestations. Given adalimumab’s expanding use, clinicians should be mindful of potential TB reactivation, emphasizing thorough screening, diagnosis, and management for improved patient care and safety amidst immunosuppressive therapies. Here, we are presenting the case of adalimumab-induced peritoneal TB.

Mediastinal Lymphadenopathy Complicating into a Bronchonodal Fistula and Lung Abscess Formation – Rare Manifestation of Drug-resistant Tuberculosis

Pulmonary tuberculosis (TB) sometimes involves regional lymph nodes like mediastinal lymph nodes. These may resolve spontaneously or on treatment; or they may enlarge and result in various complications such as extrinsic bronchial inflammation, ulceration, or rarely erode through the bronchial wall. This erosion is seen radiologically as mediastinal widening or lymphadenopathy with atelectasis and consolidation termed “epituberculosis.” This is more frequently encountered in infants than older children and extremely rarely in adults. We hereby describe a rare case of a 14-year-old girl with mediastinal lymphadenopathy complicating into a bronchonodal fistula and lung abscess formation. A diagnosis of pulmonary rifampicin-resistant TB was obtained on repeated testing of sputum for GeneXpert. The patient was started on appropriate drug-resistant TB therapy and completed therapy successfully.