TUBERCULOSIS BEYOND THE ORDINARY: A CASE SERIES INVESTIGATING PULMONARY AND EXTRA-PULMONARY PRESENTATIONS

Authors

  • KUNJAN PARESHKUMAR SHAH Department of General, Medicine, Dr. N.D. Desai Faculty of Medical Science and Research Centre, Dharmsinh Desai University, Nadiad, Gujarat, India
  • PANDYA DHRUVKUMAR JITENDRAKUMAR Department of Community Medicine, Sumandeep Vidyapeeth deemed to be University, Vadodara, Gujaraj, India
  • DEVANSHKUMAR PATEL Department of General Medicine, Dr. N.D. Desai Faculty of Medical Science and Research, Dharmsinh Desai University, Nadiad, Gujarat, India.

DOI:

https://doi.org/10.22159/ajpcr.2025v18i4.53966

Keywords:

Tuberculosis,, Pleural effusion, Extrapulmonary tuberculosis,, Diagnosis, Management,, Case series

Abstract

Objective: Despite advancements in diagnostic modalities and treatment strategies, diagnosing and managing atypical cases of pulmonary and EPTB, which can affect multiple organ systems, present unique challenges. We present a case series highlighting diverse presentations of TB, emphasizing diagnostic dilemmas and management approaches.

Methods: We conducted a retrospective analysis of patients diagnosed with Tuberculosis at our tertiary care center over a specified period. Clinical presentations, diagnostic evaluations, treatment regimens, and outcomes were systematically reviewed.

Results: We present seven cases illustrating the heterogeneity of TB manifestations. These include tuberculosis of the pleura, tuberculoma, bone marrow tuberculosis and metastasis. Each case presented distinct diagnostic challenges, such as differentiating TB from other pathologies and identifying suitable diagnostic modalities. Management strategies involved anti-tubercular therapy tailored to the site and extent of disease, often supplemented by adjunctive measures.

Conclusion: Our case series underscores the varied clinical presentations and diagnostic complexities of pulmonary and EPTB. Early recognition, a high index of suspicion, and multimodal diagnostic approaches are crucial for timely initiation of appropriate treatment. Further research is warranted to elucidate optimal diagnostic algorithms and therapeutic interventions for pulmonary and EPTB, particularly in resource-limited settings.

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References

WHO Global Tuberculosis Report; 2023. Available from: https:// www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2023 [Last accessed on 2025 Feb 02].

Solovic I, Jonsson J, Korzeniewska-Koseła M, Chiotan DI, Pace- Asciak A, Slump E, et al. Challenges in diagnosing extrapulmonary tuberculosis in the European Union, 2011. Euro Surveill. 2013 Mar 21;18(12):20432. PMID: 23557946

Yang Z, Kong Y, Wilson F, Foxman B, Fowler AH, Marrs CF, et al. Identification of risk factors for extrapulmonary tuberculosis. Clin Infect Dis. 2004 Jan 15;38(2):199-205. doi: 10.1086/380644, PMID: 14699451

Fiske CT, Griffin MR, Erin H, Warkentin J, Lisa K, Arbogast PG, et al. Black race, sex, and extrapulmonary tuberculosis risk: An observational study. BMC Infect Dis. 2010 Jan 22;10:16. doi: 10.1186/1471-2334-10-16

Al-Otaibi A, Almuneef M, Hameed T. An unusual combination of extrapulmonary manifestations of tuberculosis in a child. J Infect Public Health. 2012 Apr;5(2):203-6. doi: 10.1016/j.jiph.2011.11.005

Markowski J, Witkowska M, Gierek T, Pasternak K, Ciupińska-Kajor M, Kajor M, et al. Head and neck tuberculosis-still current problem in ENT practice. Otolaryngol Pol. 2011;65:272-5. doi: 10.1016/S0030- 6657[11]70689-8

Farah MG, Rygh JH, Steen TW, Selmer R, Heldal E, Bjune G. Patient and health care system delays in the start of tuberculosis treatment in Norway. BMC Infect Dis. 2006Feb 24;6:33. doi: 10.1186/1471- 2334-6-33

Dixit S, Verma AK, Bajpai J, Kant S, Jaiswal R, Singh A. Uncommon presentation of gastrointestinal tuberculosis - a case series. Indian J Tuberc. 2024;72:133-8. doi: 10.1016/j.ijtb.2024.06.010

Fang Y, Zhou Q, Li L, Zhou Y, Sha W. Epidemiological characteristics of extrapulmonary tuberculosis patients with or without pulmonary tuberculosis. Epidemiol Infect. 2022;150:e158.

Zürcher K, Ballif M, Kiertiburanakul S, Chenal H, Yotebieng M, Grinsztejn B, et al. Diagnosis and clinical outcomes of extrapulmonary tuberculosis in antiretroviral therapy programmes in low- and middle-income countries: A multicohort study. J Int AIDS Soc. 2019;22:e25392.

Villegas MV, Labrada LA, Saravia NG. Evaluation of polymerase chain reaction, adenosine deaminase, and interferon-gamma in pleural fluid for the differential diagnosis of pleural tuberculosis. Chest. 2000;118(5):1355-64. doi: 10.1378/chest.118.5.1355

Valdes L, Pose A, San Jose E, Martinez Vazquez JM. Tuberculous pleural effusions. Eur J Intern Med. 2003;14(2):77-88. doi: 10.1016/ s0953-6205(03)00018-9

Greco S, Girardi E, Masciangelo R, Capoccetta GB, Saltini C. Adenosine deaminase and interferon gamma measurements for the diagnosis of tuberculous pleurisy: A meta-analysis. Int J Tuberc Lung Dis. 2003;7(8):777-86.

Han DH, Song JW, Chung HS, Lee JH. Resolution of residual pleural disease according to time course in tuberculous pleurisy during and after the termination of antituberculosis medication. Chest. 2005;128(5):3240-5. doi: 10.1378/chest.128.5.3240

Modi R, Lenox R. Chest, two cases of intractable hiccups caused by TB. Chest. 2018;154(4):154A. doi: 10.1016/j.chest.2018.08

Hejazi N, Hassler W. Multiple intracranial tuberculomas with atypical response to tuberculostatic chemotherapy: Literature review and case report. Infection. 1997;25(4):233-9.

Lees AJ, Macleod AF, Marshall J. Cerebral tuberculomas developing during treatment of tuberculous meningitis. Lancet. 1980;1(8180):1208-11.

Chambers ST, Hendrickse WA, Record C, Rudge P, Smith H. Paradoxical expansion of intracranial tuberculomas during chemotherapy. Lancet. 1984;2:181-4.

Nomura S, Akimura T, Kitahara T, Nogami K, Suzuki M. Surgery for expansion of spinal tuberculoma during antituberculous chemotherapy: A case report. Pediatr Neurosurg. 2001;35:153-7.

Rao GP, Nadh BR, Hemaratnan A, Srinivas TV, Reddy PK. Paradoxical progression of tuberculous lesions during chemotherapy of central nervous system tuberculosis. Report of four cases. J Neurosurg. 1995;83:359-362.

Monteiro R, Carneiro JC, Costa C, Duarte R. Cerebral tuberculomas -a

clinical challenge. Respir Med Case Rep. 2013 Jun 3;9:34-7. doi: 10.1016/j.rmcr.2013.04.003, PMID: 26029627

Singh KJ, Ahluwalia G, Sharma SK, Saxena R, Chaudhary VP, Anant M. Significance of haematological manifestations in patients with tuberculosis. J Assoc Phys India. 2001;49:788-94.

Alghamdi AA, Awan FS, Maniyar IH, Alghamdi NA. Unusual manifestation of extrapulmonary tuberculosis. Case Rep Med. 2013;2013:353798.

Feng J, Zhang H, Zhong DR. A clinical analysis of 20 cases with bone marrow granulomas. Zhonghua Nei Ke Za Zhi. 2009;48(6):485-7.

Dalugama C, Gawarammana IB. Fever with pancytopenia: Unusual presentation of extrapulmonary tuberculosis: A case report. J Med Case Rep. 2018 Mar 6;12(1):58. doi: 10.1186/s13256-018-1596-0, PMID: 29506574

Wang JY, Hsueh PR, Wang SK, Jan IS, Lee LN, Liaw YS, et al. Disseminated tuberculosis: A 10-year experience in a medical center. Medicine [Baltimore]. 2007;86:39-46.

Paci M, Cavazza A, Ferrari G, Filice A, Sgarbi G. Figure of the month. Pulmonary tuberculosis mimicking lung metastasis. J Thorac Oncol. 2008;3:660-1. doi: 10.1097/JTO.0b013e3181757ad4

Kant S, Saheer S, Prakash V, Hasan G, Jabeed P, Husain N. Bilateral nodular pulmonary tuberculomas simulating metastatic disease. BMJ Case Rep. 2011;2011:bcr112010353913. doi: 10.1136/bcr.11.2010.3539

Pilaniya V, Gera K, Kunal S, Shah A. Pulmonary tuberculosis masquerading as metastatic lung disease. Eur Respir Rev. 2016;25:97- 8. doi: 10.1183/16000617.00002315

Ramos BG, Lima MS, Topete RO. Metastatic tuberculosis: Case report. J Am Acad Dermatol. 2011;64(2):AB102.

Morikawa K, Misumi S, Fukuda T. A case of pulmonary tuberculosis with multiple nodules mimicking lung metastases. BJR Case Rep. 2019 Apr 1;5(3):20180124. doi: 10.1259/bjrcr.20180124, PMID: 31555473

Published

07-04-2025

How to Cite

KUNJAN PARESHKUMAR SHAH, et al. “TUBERCULOSIS BEYOND THE ORDINARY: A CASE SERIES INVESTIGATING PULMONARY AND EXTRA-PULMONARY PRESENTATIONS”. Asian Journal of Pharmaceutical and Clinical Research, vol. 18, no. 4, Apr. 2025, pp. 4-11, doi:10.22159/ajpcr.2025v18i4.53966.

Issue

Section

Case Study(s)