A Case of Advanced and Serious Pulmonary and Extrapulmonary Tuberculosis

Abstract

INTRODUCTION: After decades of decline, an unprecedented resurgence in TBC occurred in the late 1980s and early 1990s, being the second leading cause of death among infectious diseases, surpassed only by HIV infection. It is not only treatable but preventable as well, being the lung the preferable target organ. In 2011 were reported 8,7 millions of new cases, of whom 1.4 millions died. The most vulnerable population is that comprised between 15 and 44 years CASE PRESENTATION: 51 years old woman, health care provider, presented with a 4 months history of pain localized in the right sacroilial joint, fever and weight loss of 20 kg.The patient general condition was bad and shortness of breath was noted. The physical examination revealed a reduction in respiratory sounds in both lungs and limited movilization of the right sacroilial joint. The oxygen saturation was 94% at room air. At the time she was admitted seizures localized in the left superior extremity occurred. The admission Chest Radiograph and CT scan revealed reticular and micronodular opacities in the the right and left upper lobes, bilateral pleural effusion and a 15 mm. lymph node enlargement in the right paratracheal area. MRI of pelvis and lumbar spine showed a cavitary lesion in the right iliac bone. A Central Nervous System CT scan showed multiple cerebral low attenuation lessions with perypheral contrast enhacement in the cortex, right frontoparietal, and cereberall area. The Cerebral MRI showed multiple nodular lessions compatible with tuberculomas. A Fiberbronchoscopy was done and a BAL obtained. It was negative for Mycobacterias and no microrganism was found. A TBLB was not done. Cerebrospinal fluid obtained by lumbar puncture was normal too. Electroencephalography showed slow waves in the occipital area. Laboratory test was only remarkable for a 70 mm sedimentation rate and a serologic examination for IgM and IgG antibodies for brucella. were negative. A tuberculin skin test was also negative. An iliac bone biopsy showed a necrotizing gigantocellular granuloma without atypia. suggestive of TBC. The differential diagnosis were done with sarcoidosis, brucellosis,lymphoma, eosinophilic granuloma and toxoplasmosis. All them were discarded by different laboratory test. DISCUSSION: Tuberculosis treatment was initiated with 4 drugs. The patient also received anticonvulsivants and analgesic medication. In 20 days the patient experienced clinical and radiographic improvement and actually she remains in good health. CONCLUSIONS: Increased poverty in marginalized groups in inner city areas, the deterioration of tuberculosis program infrastructure, the HIV/AIDS epidemic, are all factors that contribute to the burden of TBC all around the world.