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Extrapulmonary tuberculosis: a case report involving the spine and soft tissues
Affiliations.
- 1 University of Kentucky College of Medicine, 800 Rose Street MN 150, Lexington, KY 40506, USA.
- 2 Division of Musculoskeletal Radiology, Department of Radiology, University of Kentucky, 800 Rose Street HX-315D, Lexington, KY 40506, USA.
- PMID: 34178198
- PMCID: PMC8213895
- DOI: 10.1016/j.radcr.2021.05.049
Tuberculosis (TB) is a major health concern worldwide, and its incidence is increasing in developed countries, especially among immigrant populations. Extrapulmonary TB with musculoskeletal involvement is often a difficult and delayed diagnosis, as the disease can mimic metastases or infection. We present a case of extrapulmonary TB affecting the spine and soft tissues of a Vietnamese-born patient living in the United States. We discuss the imaging findings associated with extrapulmonary TB of the spine. Familiarity with key imaging features of disease can lead to early suspicion and detection of the disease as well as timely treatment.
Keywords: Extrapulmonary tuberculosis; Musculoskeletal tuberculosis; Pott's disease; Spinal tuberculosis; Tuberculosis.
© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.
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34: Tuberculosis
David Cluck
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Patient presentation.
- Full Chapter
- Supplementary Content
Chief Complaint
“I have a cough that won’t go away.”
History of Present Illness
A 63-year-old male presents to the emergency department with complaints of cough/shortness of breath which he attributes to a “nagging cold.” He states he fears this may be something worse after experiencing hemoptysis for the past 3 days. He also admits to waking up in the middle of the night “drenched in sweat” for the past few weeks. When asked, the patient denies ever having a positive PPD and was last screened “several years ago.” His chart indicates he was in the emergency department last week with similar symptoms and was diagnosed with community-acquired pneumonia and discharged with azithromycin.
Past Medical History
Hypertension, dyslipidemia, COPD, atrial fibrillation, generalized anxiety disorder
Surgical History
Appendectomy at age 18
Family History
Father passed away from a myocardial infarction 4 years ago; mother had type 2 DM and passed away from a ruptured abdominal aortic aneurysm
Social History
Retired geologist recently moved from India to live with his son who is currently in medical school in upstate New York. Smoked ½ ppd × 40 years and drinks 6 to 8 beers per day, recently admits to drinking ½ pint of vodka “every few days” since the passing of his wife 6 months ago.
Sulfa (hives); penicillin (nausea/vomiting); shellfish (itching)
Home Medications
Albuterol metered-dose-inhaler 2 puffs q4h PRN shortness of breath
Aspirin 81 mg PO daily
Atorvastatin 40 mg PO daily
Budesonide/formoterol 160 mcg/4.5 mcg 2 inhalations BID
Clonazepam 0.5 mg PO three times daily PRN anxiety
Lisinopril 20 mg PO daily
Metoprolol succinate 100 mg PO daily
Tiotropium 2 inhalations once daily
Venlafaxine 150 mg PO daily
Warfarin 7.5 mg PO daily
Physical Examination
Vital signs.
Temp 100.8°F, P 96, RR 24 breaths per minute, BP 150/84 mm Hg, pO 2 92%, Ht 5′10″, Wt 56.4 kg
Slightly disheveled male in mild-to-moderate distress
Normocephalic, atraumatic, PERRLA, EOMI, pale/dry mucous membranes and conjunctiva, poor dentition
Bronchial breath sounds in RUL
Cardiovascular
NSR, no m/r/g
Soft, non-distended, non-tender, (+) bowel sounds
Genitourinary
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Case Study of Tuberculosis - Free download as Word Doc (.doc), PDF File (.pdf), Text File (.txt) or read online for free. This case study describes a 23-year-old African American woman diagnosed with tuberculosis who did not properly follow up on her treatment.
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Extrapulmonary TB with musculoskeletal involvement is often a difficult and delayed diagnosis, as the disease can mimic metastases or infection. We present a case of extrapulmonary TB affecting the spine and soft tissues of a Vietnamese-born patient living in the United States.
Read chapter 34 of Infectious Diseases: A Case Study Approach online now, exclusively on AccessPharmacy. AccessPharmacy is a subscription-based resource from McGraw Hill that features trusted pharmacy content from the best minds in the field.