Disseminated tuberculosis: Challenges in diagnosis

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. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 7 No. 4, April 2016. ISSN – [0976-3198] Int J Case Rep Imag 2016;7(4):228–231. www.ijcasereportsandimages.com Cardoso et al. 228 CASE REPORT OPEN ACCESS Disseminated tuberculosis: Challenges in diagnosis Catarina Assis Cardoso, Teresa Filomena Garcia, Patricia Raimundo Cachado