Clinical atypical presentation of disseminated tuberculosis

Abstract

Disseminated Tuberculosis is a potentially lethal disease if not diagnosed and treated early. Therefore a high index of clinical suspicion for early diagnosis and timely institution of anti-tuberculosis treatment is important. We report a case of an elderly female who presented with complaints of weight loss, generalised fatigue, altered sensorium and moderate hypercalcemia. Investigations excluded multiple myeloma and hyperparathyroidism. A PET scan to rule out occult malignancy showed suspicious uptake in juxtaphrenic nodes and terminal ileum. Biopsy of lymph nodes showed granulomatous inflammation with detection of Mycobacterium tuberculosis by GeneXpert. Culture of the tissue yielded Mycobacterium tuberculosis. The patient showed good clinical response to anti-tuberculosis treatment.