Hepatic tuberculosis (TB) is an uncommon extrapulmonary manifestation of tuberculosis. Hepatic TB is more common in immunocompromised patients, such as those on immunosuppressive medications or those with a human immunodeficiency virus (HIV) infection. Primary hepatic TB is rare, and liver involvement is often secondary to spreading from the lymphatics, portal vein, or hepatic artery. We report a case of hepatic TB in a patient on adalimumab for ankylosing spondylitis (AS).

Muscular tuberculosis as a primary focal lesion in an immunocompetent individual without any underlying bone involvement is a rare finding. The authors present a case of a young female in her 30s who presented with complaints of recurrent discharging sinus in the posteromedial aspect of the proximal right thigh for eight months. The patient was treated by surgical debridement followed by antitubercular therapy (ATT) and has shown full recovery during the post-eight-month treatment period. Such a presentation of primary tubercular pyomyositis imposes a diagnostic as well as a therapeutic challenge.

Tuberculosis (TB) remains a significant global health challenge. Miliary TB is a rare manifestation of TB that involves systemic lymphohematogenous dissemination of infection and presents diagnostic challenges due to its often asymptomatic or non-specific nature. This case report documents a rare occurrence of gastrointestinal (GI) bleeding secondary to miliary TB without pulmonary symptoms in an 81-year-old Filipino-American male living in the United States. Extensive imaging studies revealed a mass in the right colon with multiple bleeding vessels draped around it; it was not amendable to treatment with embolization and required right hemicolectomy with end ileostomy. The pathology report of the excised mass demonstrated miliary TB with necrotizing granulomas and granulomatous lymphadenopathy involving 23 lymph nodes. The patient was started on anti-tuberculosis medical management; however, the patient remained clinically unstable and expired on postoperative day 39. This case highlights the importance of the heightened clinical awareness required during times of globalization and in regions with dense immigrant populations. We aim to delineate the clinical understanding of gastrointestinal TB (GITB) and review possible indications for surgical management. We aim to help reduce diagnostic delay, therefore improving patient outcomes and limiting the spread of disease.

Parietal thoracic tuberculosis is a rare localization of tuberculosis. It reaches the ribs and intercostal spaces due to hematogenous spread or direct transcutaneous inoculation. The diagnosis of tuberculosis must be evoked given the endemic context, even in immunocompetent patients. Surgical excision associated with medical treatment remains the best treatment in this case to avoid any local or distant recurrence.

The COVID-19 pandemic has significantly impacted the global health system as well as the social and economic impact on tuberculosis (TB) treatment and diagnostic services. A high volume of patients diagnosed and treated for TB were impacted by the pandemic restrictions, particularly reduced access to TB services provided by the National Tuberculosis Elimination Programme in India; this in turn increased the number of deaths due to TB. The Indian healthcare system has been struggling with the eradication of TB, and this additional worldwide health crisis caused by SARS-CoV-2 has put the Indian healthcare system under severe stress. Both COVID-19 and TB are infectious diseases that primarily affect the lungs and have similar symptoms such as cough, fever, and difficulty breathing. The need of the hour is to take proper actions to mitigate and reverse these impacts urgently. The immediate priority is to aggressively step up the provision of essential TB services so that the levels of TB case detection and treatment return to at least pre-COVID-19 levels. The diagnosis of genital TB especially needs a high index of suspicion, as most of the cases are asymptomatic and diagnosed by chance in young women being evaluated for fertility. Here, we present a series of advanced genital TB cases that required intensive care and could have been detected and treated at an early stage.

Tuberculosis of the hip is a relatively rare type of septic arthritis that is seldom seen in the developed world today. While pyogenic septic arthritis may present with clear features that help in early diagnosis and treatment, many of these features are absent or overlap significantly with tuberculous arthritis, making the diagnosis a clinical challenge. Here, we present a case of tuberculous septic arthritis seen in our clinic following the surgical incision and drainage of a groin abscess with minimal hip symptoms. We discuss the therapeutic approach for the patient and briefly review other reported cases of tuberculous septic arthritis in the literature.

This paper reports on the unlikely case of a 68-year-old man presenting with a non-resolving, mild lower respiratory tract infection, subsequently diagnosed with pericardial tuberculosis (TB) in the absence of TB risk factors and with negative TB serology. Pericardial and pleural effusions were found incidentally on CT pulmonary angiogram, with a small pericardial effusion without tamponade seen on the echocardiogram. During his three-month inpatient stay, the patient was rarely very unwell, though no treatment led to clinical and biochemical resolution of symptoms. Later deterioration prompted another echocardiogram, which found a moderate-sized pericardial effusion, septal bounce, and new regional wall motion abnormalities. To avert the impending cardiac tamponade, the patient underwent pericardiectomy, which provided a tissue diagnosis of TB. Pericardial TB is extremely uncommon, especially outside of TB endemic regions, though it is well described. This case is especially noteworthy, as serology, bronchial washings, and pleural aspirate had been negative for TB though a Quantiferon test was positive. The diagnosis was only confirmed after pericardiectomy. The patient was subsequently treated with anti-TB therapy, with a good clinical response. This case highlights diagnostic challenges and strategies for investigating and managing similar complex scenarios, particularly in non-endemic settings.

The incidence of tuberculosis (TB) worldwide is still significantly high, with India contributing a high global TB burden. This case study features a 49-year-old male who had complaints of pain and abdominal distention for one and a half months. An erect abdominal radiograph showed features suggesting small bowel obstruction. Contrast-enhanced computed tomography (CT) of the abdomen was done. It showed multiple strictures involving the distal jejunum and ileum, causing small bowel obstruction. There was mesenteric and retroperitoneal lymphadenopathy with central necrosis and ascites. The patient was operated on for a small bowel obstruction. The resected intestine showed four strictures, tiny nodules on the serosal surface, and many enlarged lymph nodes. Representative tissue from these areas showed the typical picture of multiple caseating granulomas and fibrosis. Ziehl-Neelsen (ZN) staining highlighted the acid-fast bacilli (AFB). The suspicion index for intestinal tuberculosis (ITB) should be kept high while evaluating patients with intestinal obstruction presenting in endemic areas and high-risk populations, such as HIV-infected, undernourished, immunocompromised, and those with diabetes, smoking, and alcohol addiction.

According to the World Health Organization (WHO), tuberculosis (TB) is the 13th cause of death worldwide and the second infectious killer after HIV. It is an endemic disease in Morocco. Isolated appendicular TB is an uncommon form of extrapulmonary TB. We report a case of a 26-year-old woman admitted for acute abdominal pain in the right iliac fossa with fever, vomiting, and diarrhea. Physical examination and abdominal ultrasound confirmed appendicitis. Surgery was performed and revealed on histopathological examination of the resected appendix the diagnosis of tubercular appendicitis. The patient was initiated on the conventional antitubercular regimen for six months and would be followed up appropriately. This case report highlights the importance of histopathological examination of appendicectomy specimens in order to diagnose rare diseases such as primary TB of the appendix.

Tuberculous meningitis (TBM), the most severe form of tuberculosis, causes death in approximately 25% cases despite antibiotic therapy, and half of survivors are left with neurological disability. Mortality and morbidity are contributed to by a dysregulated immune response, and adjunctive host-directed therapies are required to modulate this response and improve outcomes. Developing such therapies relies on improved understanding of the host immune response to TBM. The historical challenges in TBM research of limited in vivo and in vitro models have been partially overcome by recent developments in proteomics, transcriptomics, and metabolomics, and the use of these technologies in nested substudies of large clinical trials. We review the current understanding of the human immune response in TBM. We begin with M. tuberculosis entry into the central nervous system (CNS), microglial infection and blood-brain and other CNS barrier dysfunction. We then outline the innate response, including the early cytokine response, role of canonical and non-canonical inflammasomes, eicosanoids and specialised pro-resolving mediators. Next, we review the adaptive response including T cells, microRNAs and B cells, followed by the role of the glutamate-GABA neurotransmitter cycle and the tryptophan pathway. We discuss host genetic immune factors, differences between adults and children, paradoxical reaction, and the impact of HIV-1 co-infection including immune reconstitution inflammatory syndrome. Promising immunomodulatory therapies, research gaps, ongoing challenges and future paths are discussed.