Topic:

Tuberculosis and other mycobacterial infections

Abstract No.:

ISE.117

Title:

Miliary and extrapulmonary tuberculosis with lymph node, bone, muscle and lytic lesion of lumbar spine in a non HIV young male

Author(s):

N. Qumsiyeh¹, T. Gounaris², E. Sioula², P. Gounari², G. Tzagkarakis¹, A. Kwnstantinou³, G. Gewrgantonis¹; ¹EVAGGELISMOS HOSPITAL, internal medicine, Athens/GR, ²Evaggelismos General Hospital, Internal Medicine, Athens/GR, ³EVAGGELISMOS HOSPITAL, internal medicine, Hlioupoli, Athens/GR

Abstract:

Background: A 22 year old young male from Sudan presented to the emergency department complaining of back pain for three months, non-responsive to pain killers. Five days earlier he was examined for a painful swelling in his right abdominal region and a muscle abscess was drained. He denies any cough, fever or weight loss. He also has pain in his left jaw and difficulty chewing for the past two days.He lives in Greece for 3 years. His past medical history is free for chronic disease.On physical examination he appeared to be ill, in pain. He was found to have low grad fever (37.8 ⁰c) and mild tachycardia. His breathing sounds were normal. The site of the surgical incision is about 3cm above the right upper iliac crest, with pussy discharge. He had Mild hepatospenomegaly.Mild tenderness is noted with pressure on the spine at the level of T12-O1. Edema and tenderness are also noted at the left temporomandibular  joint, with decreased range of motion.Chest X-Ray revealed bilateral infiltrates. An ultrasound of the abdomen revealed an enlarged spleen with multiple low density lesions. A low density mass of about 3cm is also seen at the splenic helium. His laboratory tests were unremarkable. His HIV and hepatitis tests returned negative.A total body CT scan showed bilateral pulmonary infiltrates, mediastinal lymph node enlargement, lytic lesion of the T1 thoracic spine and a hypo-dense lesion of the psoas muscle.Pus and gastric fluid smear and culture were positive for acid-fast bacilli. The diagnosis of military tuberculosis was confirmed and a quadruple treatment was initiated.
Methods: A case report of miliary tuberculosis.