Extrapulmonary tuberculosis is rare. Tuberculous involvement of the scapula is an infrequently reported entity. Such cases are exceptionally rare, as there is no documented case of an isolated primary rifampicin mono-resistant extrapulmonary tuberculosis of the scapula with cold abscesses in the medical literature. This case report features a 25-year-old Indian male patient whose main complaint was a painful swelling with a discharging sinus in his left shoulder that limited his range of motion. A thorough blood workup, clinical assessment, and scans led to a definitive diagnosis. The patient was commenced on antituberculous therapy.

Tuberculosis is common in endemic countries. However, extrapulmonary tuberculosis is relatively rare, and primary extrapulmonary rifampicin mono-resistant tuberculosis of the cervical, mediastinal, and axillary lymph nodes simultaneously without pulmonary focus in an immunocompetent male has never been reported. Herein is a case of a 27-year-old Indian male with no previous history of tuberculosis who was diagnosed after an extensive clinical assessment with a radiometric and cartridge-based nucleic acid amplification assay of the swollen lymph nodes. He was put on antituberculous treatment per the all-oral longer regimen of the national program.

Tuberculosis remains a persistent global health challenge, demanding swift and accurate diagnostic methods for effective treatment. The emergence of the Xpert MTB/RIF Ultra system marks a significant milestone in combating tuberculosis, streamlining the identification of Mycobacterium tuberculosis, and advancing our pursuit of eradicating the disease. Delving into the therapeutic landscape of tuberculosis and rifampicin resistance, this scientific narrative review offers a comprehensive exploration. It begins by delving into the historical backdrop and the hurdles encountered with traditional tuberculosis diagnostics. From there, it traces the journey of the Xpert MTB/RIF technology, underscoring its molecular underpinnings. In this narrative review, the performance of the Xpert MTB/RIF Ultra system undergoes thorough scrutiny, encompassing investigations into sensitivity, specificity, and comparisons with alternative diagnostic methods. The spotlight shines on its clinical applications across diverse scenarios, from diagnosing pulmonary and extrapulmonary tuberculosis to its pivotal role in identifying rifampicin resistance. The study also evaluates its clinical efficacy in enhancing patient outcomes and supporting global tuberculosis control initiatives. However, the review does not shy away from discussing the challenges and limitations associated with the Xpert MTB/RIF Ultra system. It meticulously addresses concerns regarding cost, infrastructure requirements, and potential diagnostic inaccuracies. Offering a panoramic view, the review assesses the system\'s impact in resource-constrained settings and its potential to bolster tuberculosis elimination endeavors worldwide. Peering into the future, it explores ongoing research avenues and potential enhancements in Xpert MTB/RIF Ultra technology, envisioning a landscape of improved performance, broader applications, and emerging diagnostic innovations in the realm of tuberculosis diagnostics.

Drug-resistant tuberculosis is a noteworthy threat to public health, especially in high-burden countries. Management of these types of tuberculosis is lengthy and associated with a number of adverse drug reactions. Pre-extensively drug-resistant tuberculosis is a serious type of disease that is caused by the strains of Mycobacterium tuberculosis that are resistant to either rifampicin or both, i.e., rifampicin and isoniazid, and resistant to any fluoroquinolones. A splenic hydatid cyst is relatively rare and has never been reported in a case of pre-extensively drug-resistant pulmonary tuberculosis. The present case is a rare case of a young Indian male who was diagnosed with pre-extensively drug-resistant pulmonary tuberculosis through a cartridge-based nucleic acid amplification test and second-line drug susceptibility testing. Further, a diagnostic radiometric investigation showed a giant hydatid cyst in the spleen. He was started on an all-oral longer treatment regimen per the existing protocols. However, his treatment was associated with multiple adverse drug reactions.

Skeletal tuberculosis is a rare form of extrapulmonary tuberculosis. Due to non-specific clinical features, these cases are often diagnosed very late, ultimately affecting treatment outcomes. The present case is a very rare case of tuberculosis of the iliac bone and acetabulum with iliopsoas, obturator internus, and obturator externus abscesses in an Indian female. She reported pain in her right hip and a limp. It was a difficult diagnosis, especially due to the rare involvement of bones and muscles in the absence of any lesions in the lungs. Nevertheless, the diagnosis was achieved by a detailed radiometric and laboratory workup. She was initiated on antituberculous treatment per her weight for 12 months.

Tuberculosis is prevalent in high-burden countries. Extrapulmonary drug-resistant tuberculosis is exceedingly rare. Simultaneous involvement of the spine with psoas muscles in the absence of pulmonary seeding with a drug-resistant strain of Mycobacterium tuberculosis in an adult female is never reported. A 33-year-old Indian female presented with complaints of chronic back pain for eight months. She was on antituberculous treatment for Pott\'s spine for six months. The diagnosis was challenging due to the paucibacillary nature of the disease, and it required a high index of suspicion backed by radiometric investigations, liquid culture, a line probe assay, and cartridge-based nucleic acid amplification of the pus. Further, her treatment was associated with multiple adverse drug reactions like a rise of QTcF (QT corrected for heart rate by Fridericia\'s cube root formula) on the electrocardiogram, peripheral neuropathy, and abnormal behavior (decreased awareness and anger outbursts with restlessness), which were addressed by a team of experts including a cardiologist, a psychiatrist, a neurologist, and an infectious disease expert. She was managed conservatively, with an 18-month-long antituberculous treatment, which was stopped after consultation with an orthopedist at a nodal drug-resistant tuberculosis center with the advice to consult the orthopedic outpatient department; however, she was lost to follow-up.

Extrapulmonary tuberculosis is a relatively infrequent occurrence. Tubercular involvement of the chest wall is rare. There has never been a record of an isolated primary rifampicin mono-resistant extrapulmonary tuberculosis presenting as a posterior chest wall abscess in the medical literature, making such cases extremely uncommon. In this case report, a 17-year-old Indian male is presented who reported chief complaints of a painless swelling in the posterior chest wall. A comprehensive lab workup ultimately resulted in a conclusive diagnosis. Following the national guidelines, the patient was started on an anti-tubercular treatment.

Tuberculosis presentation at sites other than the lungs is relatively infrequent, and isolated knee involvement without a pulmonary focus is exceptionally rare. Furthermore, there have been no reported cases of primary rifampicin mono-resistant extrapulmonary tuberculosis of the knee in males. In this case, a 24-year-old male patient presented with pain and swelling in his left knee after a fall five years ago. Given the absence of a history of tuberculosis, arriving at a diagnosis posed a significant challenge. However, the diagnosis was ultimately established through cartridge-based nucleic acid amplification tests and clinical link-up with radiometric techniques. Management was based on the latest national guidelines for anti-tuberculous treatment, which were tailored to his weight. To date, he has completed nine months of treatment with a significant improvement in his symptoms. This rare presentation emphasizes the need for a high degree of suspicion even in extrapulmonary tuberculosis cases.

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.

Mycobacterium tuberculosis is a significant issue in endemic countries. The most common manifestation of skeletal tuberculosis in children is spondylitis, also known as Pott disease, but it may rarely involve small bones. Usually, a pulmonary focus is present from where the bacteria reach the extremities, but an isolated tuberculous involvement of the left index finger in a child without any pulmonary seeding is rare. It is a challenging diagnosis due to a lack of awareness among primary care physicians, the paucibacillary nature of the disease, and overlapping clinical features with other musculoskeletal disorders. A 13-year-old girl was brought in with complaints of pain, swelling, and discharging sinuses from her left index finger. A diagnosis was achieved after a histopathological correlation of clinical and radiological findings. She was started on anti-tubercular treatment for 12 months.