Multifocal Tuberculosis Revealed by Cutaneous Abscesses in an Immunocompetent Patient
B.Imillou *
Internal Medicine Department, Ibn Rochd University Hospital Center, Casablanca, Morocco.
N.El Moudni
Internal Medicine Department, Ibn Rochd University Hospital Center, Casablanca, Morocco.
L.Barakat
Internal Medicine Department, Ibn Rochd University Hospital Center, Casablanca, Morocco.
K.Echchilali
Internal Medicine Department, Ibn Rochd University Hospital Center, Casablanca, Morocco.
M.Moudatir
Internal Medicine Department, Ibn Rochd University Hospital Center, Casablanca, Morocco.
H.El Kabli
Internal Medicine Department, Ibn Rochd University Hospital Center, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Multifocal tuberculosis (MTB) is defined as the involvement of two or more non-contiguous extrapulmonary sites, with or without associated pulmonary TB. It is a rare and severe form, accounting for only 10% of extrapulmonary TB cases. Multifocal TB can affect immunocompetent individuals. Its varied presentation can mislead clinicians, emphasizing the need for a thorough assessment of TB dissemination. This study presents the case of 26-year-old male who had a year-long history of pelvic and spinal pain, without signs of enthesitis or peripheral involvement. Bone biopsy confirmed granulomatous tuberculoid inflammation without necrosis, strongly suggesting multifocal tuberculosis (bone and skin). The patient received anti-tuberculosis treatment with rifampicin, isoniazid, pyrazinamide, and ethambutol for two months, followed by rifampicin and isoniazid alone to complete a 12-month course.
Presentation of multifocal tuberculosis is rare but is possible in the immunocompetent host; thus, it should be kept in the differential diagnosis even in the absence of immunosuppression. Imaging and histopathological studies aid in confirming the diagnosis allowing for early and appropriate anti-tuberculosis treatment. The case presented illustrates the importance of considering broad differential diagnoses when managing some atypical and disseminated infections.
Keywords: Multifocal tuberculosis, immunocompetent individuals, mycobacterium tuberculosis, granulomatous tuberculoid inflammation, cutaneous abscesses, osteoarticular tuberculosis, tuberculosis sacroiliitis, extrapulmonary tuberculosis, bone biopsy, MRI in tuberculosis, histopathological diagnosis, anti-tuberculosis treatment