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

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 Mycobacterium tuberculosis 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. 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. Haematologic parameters revealed pancytopenia and abdominopelvic ultrasound showed hepatosplenomegaly. Erythrocyte sedimentation rate and chest X-ray were normal. Patient died after few days on admission and post-mortem examination was in keeping with disseminated tuberculosis, with liver, spleen, pancreas, para-aortic lymph nodes, pleural, omentum and stomach wall involvement.