结核病(TB)是全球主要的健康负担,尤其是像印度这样的发展中国家。虽然最常见的表现是肺结核,也可能发生涉及其他身体系统的肺外结核,提出诊断挑战。我们介绍了一名来自印度的24岁有免疫能力的男子的病例,他表现出罕见且复杂的播散性肺外结核病。病人有一个无症状的脑空化病变,可能是结核瘤,颈淋巴结病,颈部的小皮下集合,骶骨的破坏性溶解性损伤,和左侧臀侧/椎旁区域的皮下集合,所有这些都没有肺部受累。这种表现的组合以前没有报道过。颈部淋巴结肿大和皮下脓肿缓慢生长是指导诊断检查的重要线索。对结核病的怀疑指数很高,即使在非典型表现和免疫能力强的个体中,是至关重要的,特别是在高结核病负担地区。该病例强调了在鉴别诊断中考虑播散性肺外结核的重要性。即使没有肺部受累和典型的危险因素。高度怀疑,多学科方法,全面的诊断检查对于及时识别和管理这些具有挑战性的疾病至关重要。
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.