Tuberculosis (TB) is a major global health burden, particularly in developing countries like India. While the most common presentation is pulmonary TB, extrapulmonary TB involving other body systems can also occur, posing diagnostic challenges. We present the case of a 24-year-old immunocompetent man from India who exhibited an uncommon and complex presentation of disseminated extrapulmonary TB. The patient had an asymptomatic brain cavitated lesion, likely tuberculoma, cervical lymphadenopathy, a small subcutaneous collection in the neck, a destructive lytic lesion in the sacrum, and a subcutaneous collection in the left gluteal/paraspinal region, all in the absence of pulmonary involvement. This combination of manifestations has not been previously reported. The presence of cervical lymphadenopathy and a slowly growing subcutaneous abscess were important clues that guided the diagnostic workup. Maintaining a high index of suspicion for TB, even in atypical presentations and immunocompetent individuals, is crucial, particularly in high-TB-burden regions. This case highlights the importance of considering disseminated extrapulmonary TB in the differential diagnosis, even in the absence of pulmonary involvement and typical risk factors. A high index of suspicion, a multidisciplinary approach, and a comprehensive diagnostic workup are essential for the timely recognition and management of these challenging conditions.

The immune system is the body\'s defense system against infection, pathogenic organisms, or foreign bodies. Human immunodeficiency virus (HIV) infection significantly reduces the number of cells involved in the immune system making the infected person prone to a greater number of infections like tuberculosis (TB). HIV infection reduces the CD4 T helper cell count and further replicates within the body. HIV-TB is a major health concern as there is more chance of progression to acquired immunodeficiency syndrome (AIDS) and the emergence of drug-resistant TB. In this case report, we see how the HIV-TB infection affects the body, significantly affecting the morbidity and mortality of the patient.

Epididymal tuberculosis is rare and often presents diagnostic difficulties. It may be indicative of a disseminated form of the infection, which is the case of our patient. A 19-year-old man, with no past medical history, was admitted for a swollen painful left scrotum that had been evolving for 8 months. He had undergone an orchiectomy and the anatomopathological examination was consistent with epididymal tuberculosis. The radiological investigations had revealed other localizations of the infection: lymphatic, pulmonary, parietal and osteoarticular tuberculosis. Anti-tuberculosis therapy was introduced. However, in the 4th month of treatment, the patient developed seizures. A cerebral magnetic resonance imaging was practiced, concluding to cerebral tuberculomas. Anti-tuberculosis treatment was continued associated to an anticonvulsant with a favourable outcome. The originality of our observation resides in the mode of revelation of a disseminated paucisymptomatic tuberculosis, by an epididymal localization, in an immunocompetent patient.

Tuberculosis is usually seen in the lungs. However, the involvement of various extrapulmonary sites is due to the spread of the bacteria via blood, lymphatic, or direct inoculation. The present case is a rare presentation of tuberculosis in an Indian female who came with complaints of swelling in her right elbow joint, headache, and cough with expectoration. A diagnostic evaluation resulted in the isolation of Mycobacterium tuberculosis from the sputum samples and elbow joints, which was further supported by an exudative picture on the cerebrospinal fluid examination. The findings were supported by advanced radiometric techniques. She was commenced on an antituberculous treatment per her weight. Disseminated tuberculosis is a challenging diagnosis as there is often a delay in clinical presentation, a lack of awareness about the possibility of multiple sites with tuberculous infection in clinicians, and a time lag in the availability of the culture results.

OBJECTIVE: This systematic review aimed to evaluate the published cases with miliary brain lesions and their etiological factors, clinical manifestations, diagnostic procedures, and outcomes.
METHODS: A comprehensive search of PubMed, Scopus, Embase, and Google Scholar was conducted using the specified search strategy. Eligibility criteria included cases with miliary lesions in the brain confirmed through neuroimaging and various diagnostic procedures. The PRISMA guidelines were followed, and the PROSPERO registration number for the protocol is CRD42023445849.
RESULTS: Data from 130 records provided details of 140 patients. Tuberculosis was the primary cause in 93 cases (66.4%), malignancies in 36 cases (25.7%), and other causes accounted for the remaining 11% cases. Tuberculosis patients averaged 35.7 years old, while those with malignancies averaged 55.44 years. Tuberculosis symptoms primarily included fever, headache, and altered sensorium, whereas malignant cases often exhibited progressive encephalopathy, headache, and specific neurological deficits. Distinctive indicators for CNS tuberculosis were choroidal tubercles and paradoxical reactions. Additionally, 63 tuberculosis patients showed miliary lung shadows and 49 had abnormal CSF findings. For the malignancy group, 13 exhibited miliary lung lesions, and 8 had CSF abnormalities. Regarding outcomes, a significant mortality disparity was observed, with 58.3% in the malignancy group, compared to 10.8% in the tuberculosis group and 27.3% in other cases.
CONCLUSIONS: Miliary brain lesions are a crucial imaging abnormality that necessitates prompt work up. In an immunocompromised state, diagnostic possibilities of miliary brain lesions are more varied and often pose a bigger challenge.

In tuberculous patient, abnormal extrarenal production of 1.25-dihydroxyvitamin D3 by activated macrophages results in hypercalcemia. High calcium level associated with tuberculosis is frequent in adults with active pulmonary tuberculosis even though most patients are asymptomatic, while hypercalcemia in children due to disseminated tuberculosis is rare. Here, we described a case of a 5-year-old who presented with cough and right anterior chest swelling of two-month duration with an Erythrocyte Sedimentation Rate of 144mm/hour, and a high serum ionized calcium level of 1.46millimol/L. With the epidemiologically prevalence, clinical and radiological imaging findings the diagnosis of disseminated tuberculosis to lung, pleura, lymph node, liver and bone was made, and the child was started with the anti-tuberculosis treatment, hypercalcemia was attributed to the disseminated tuberculosis precipitated by high calcium meal intake and excessive sun exposure. Tuberculosis can be complicated with hypercalcemia; care must be taken in supplementing vitamin D and high calcium meals especially in high sun exposure geographic areas.

In India, tuberculosis (TB) has the second highest disease burden following diabetes mellitus. During the COVID-19 pandemic, there was a surge of several opportunistic infections. In this case series, we report five patients, including three adults and two adolescents, who have developed various forms of TB disease after symptomatic COVID-19 pneumonia. The average time for development of post-COVID TB was 48 days. Adolescent patients have developed disseminated TB, which can be due to COVID-19-induced immunological injury or its treatment-related immune suppression. All the adult patients had high CT severity scores (CTSS) and required the administration of intravenous steroids during their COVID-19 pneumonia. Various presentations of TB were secondary spontaneous pneumothorax, miliary TB, consolidation, and nodular infiltrates. One patient had a drug-induced liver injury, which complicated the treatment of that patient. Factors that may contribute to the development of post-COVID TB are diabetes mellitus, increased severity of COVID-19 pneumonia manifested by CTSS, and administration of intravenous steroids. Bidirectional screening of TB had to be done when patients present with symptoms of COVID-19 pneumonia.

Tuberculosis is mainly known to affect the lungs, but it can manifest at various extrapulmonary sites. Disseminated tuberculosis is a relatively rare clinical condition, and cases with no history of the disease are sparse. A case of an 18-year-old Indian male is presented. He came with complaints of chest pain, coughing with expectoration, and loss of appetite. The diagnostic workup led to a definite diagnosis of disseminated tuberculosis with involvement of the lungs, pleura, mediastinal lymph nodes, and pericardium. He was initiated on a fixed-dose anti-tubercular treatment per the national guidelines.

Disseminated tuberculosis is an uncommon but devastating form of tuberculosis, possibly developing with the immune response of patients. COVID-19 infection may produce an immunosuppressive effect with possible implications for tuberculosis dissemination.
A 17-year-old female patient with a history of tuberculous pleurisy presented to the hospital with a high fever and life-threatening dyspnea after contracting a COVID-19 infection. Her condition deteriorated rapidly with grand mal epilepsy and acute gastrointestinal bleeding with a grossly depressed CD4 T-cell count, which was indicative of her profoundly immunosuppressed state. After identifying Mycobacterium tuberculosis in her cerebrospinal fluid and a subcutaneous abscess in her left lower back, she was diagnosed with disseminated tuberculosis involving both lungs, the central nervous system, the terminal ileum, the liver, bilateral adnexal tissue, and subcutaneous soft tissue in accordance with the chest and abdominal CT. Empirical treatment was initiated with dexamethasone (5 mg/day) and an anti-tuberculosis regimen of isoniazid, rifampicin, pyrazinamide, amikacin, and meropenem, which was replaced with faropenem after she left the hospital. The therapeutic effect was considered satisfied in the second month of follow-up.
To the best of our knowledge, we report the first case report of disseminated tuberculosis after COVID-19 infection. Tuberculosis may disseminate and progress during the COVID-19 pandemic, requiring more significant studies to provide better diagnosis and treatment options for the co-infection.

Drug-resistant tuberculosis is a perpetual threat to public health. In recent years, there has been an increase in the number of cases of this deadly Mycobacterium tuberculosis infection. The present case is a very rare case of primary disseminated pre-extensively drug-resistant tuberculosis of the lungs, pleura, chest wall, and abdomen in a 19-year-old Indian female patient who presented with fever, cough, abdominal pain, and anterior chest wall swelling. The diagnosis was established by a detailed laboratory and radiological workup. An all-oral longer regimen was initiated per national guidelines and according to her weight.