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Case Report
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| Disseminated tuberculosis: Challenges in diagnosis | ||||||
| Catarina Assis Cardoso1, Teresa Filomena Garcia2, Patricia Raimundo Cachado2 | ||||||
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1MD, Internship Medical Doctor; Internal Medicine Department, Santa Marta Hospital, Lisbon, Portugal.
2MD, Assistant medical doctor; Internal Medicine Department, Santa Marta Hospital, Lisbon, Portugal. | ||||||
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| How to cite this article |
| Cardoso CA, Garcia TF, Cachado PR. Disseminated tuberculosis: Challenges in diagnosis. Int J Case Rep Imag 2016;7(4):228–231. |
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Abstract
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Introduction:
Disseminated tuberculosis is difficult to identify and probably underdiagnosed. Its prevalence in non-HIV patients is rising and a high index of suspicion must always be present, especially when other diseases are present, because there is usually considerable signs and symptoms overlap between them. Also, difficulties in obtaining adequate tissue specimens and body fluids is frequent not only because the patient may not be able to undergo some procedures but also adequate biological samples amount and material processing in high quality laboratories is needed to reach a definitive diagnosis.
Case Report: A case of a 67-year-old male with a past medical history of alcoholism and diabetes presented with cachexia, right pleural effusion, abdominal ascites and bilateral leg edema. Isolated thrombocytopenia was present. Heart failure was first diagnosed, but thrombocytopenia worsening led us to a high suspicion for tuberculosis. A series of factors such as heart failure treatment and restraints on adequate tissue biopsy specimens for histopathological and microbiological evidence delayed diagnosis. Bone marrow biopsy was the key for a conclusion. However, despite therapy, the patient's condition did not improve and he passed away. Post-mortem examination revealed the extension of the disease. Conclusion: Late diagnosis and treatment is one of the reasons why disseminated tuberculosis has such high rate mortality, so our aim is to raise awareness for its early identification with appropriate use of invasive procedures and also provide an example of some restraints that might preclude diagnosis, which physicians should pay attention to. | |
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Keywords:
Bone marrow, Biopsy, Diagnosis, Disseminated tuberculosis
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Author Contributions
Catarina Assis Cardoso – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published Teresa Filomena Garcia – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published Patricia Raimundo Cachado – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2016 Catarina Assis Cardoso et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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