Main Article Content
Tuberculosis remains one of the infections with high mortality rate. Multifocal tuberculosis usually affects immune compromised patients such as Human Immunodeficiency virus carriers. However, patients with no underlying immunodeficiency may still present an extensive and atypical form of tuberculosis. We hereby report the case of a 16-year-old female patient presenting persistent and multiple cutaneous lesions associated with fatigue and loss of appetite which led to the diagnosis of disseminated, multifocal tuberculosis with neurological, musculoskeletal, genital, pulmonary, peritoneal and lymph nodes involvement. Screening for potential underlying immunodeficiency yielded no results. Clinical and radiological outcome was favorable on anti-tuberculosis drugs with complete regression of identified lesions. This case serves as a reminder that tuberculosis remains a challenging diagnosis that encompasses a variety of clinical presentation ranging from cutaneous abscesses to life-threatening conditions such as cerebral tuberculomas even in immune competent patient.
WHO. Global tuberculosis report 2019. World Health Organization; 2019.
Shivakoti R, Sharma D, Mamoon G, Pham K. Association of HIV infection with extrapulmonary tuberculosis: A systematic review. Infection. 2017;45(1):11-21.
Abdelmalek R, Mebazaa A, Berriche A, Kilani B, Ben Osman A, Mokni M, et al. Cutaneous tuberculosis in Tunisia. Médecine et Maladies Infectieuses. 2013; 43(9):374–8.
Boulahri T, Taous A, Berri MA, Traibi I, Rouimi A. Multiple meningeal and cerebral involvement revealing multifocal tuber-culosis in an immunocompetent patient. Pan Afr Med J. 2016;25:231.
Rezgui A, Fredj FB, Mzabi A, Karmani M, Laouani C. Multifocal tuberculosis in immunecompetent patients. Pan Afr Med J. 2016;24:13.
Amraoui N, Krich S, Meziane M, Gallouj S, Abid H, Elmrini A, et al. Cutaneous tuberculosis revealing multifocal tuber-culosis in immunocompetent patients. Int J Mycobacteriol. 2015;4(3):255-7.
Sanke S, Chander R, Dalal K, Agarwal S. Metastatic tubercular gummas and splenic tuberculoma secondary to tubercular lymphadenitis in an immunocompetent female. Int J Dermatol. 2018;57(10):1229-32.
Hill MK, Sanders CV. Cutaneous tuberculosis. Microbiol Spectr. 2017;5(1).
Efared B, Sidibé IS, Erregad F, Hammas N, Chbani L, El Fatemi H. Female genital tuberculosis: A clinicopathological report of 13 cases. J Surg Case Rep. 2019; 2019(3):rjz083.
Sharma JB, Sharma E, Sharma S, Dharmendra S. Female genital tuberculosis: Revisited. Indian J Med Res. 2018;148(Suppl):S71-S83.
Nataprawira HM, Ediwan NA, Diana IA, Dwiyana RF, Febrina D. Multifocal osteomyelitic tuberculosis at rare locations with metastatic tuberculosis abscess. Am J Case Rep. 2019;20:503-7.
Catherinot E, Fieschi C, Feinberg J, Casanova JL, Couderc LJ. Genetic susceptibility to mycobacterial disease: Mendelian disorders of the Interleukin-12 – Interferon-axis. Rev Mal Respir. 2005; 22(5 Pt1):767-76.