Coexistence of Miliary Tuberculosis with Tubercular Sacroiliitis in a Young Immunocompetent Female.

ABSTRACT

The incidence of musculoskeletal tuberculosis accounts for about one-third of all cases of tuberculosis occurring in extra pulmonary sites. The involvement of sacroiliac joint is rare and is commonly seen in immunocompromised young adults. Here we report the case of a 22-year-old immunocompetent female who presented to us with breathlessness, cough, lower back pain on right side and high-grade fever of 15 days duration. HRCT showed miliary mottling of both the lungs. MRI hip with sacroiliac joints revealed sacroiliitis. A Mantoux test was positive with 22 mm induration after 48 hours. Sputum AFB was positive for Mycobacterium tuberculosis. Sputum CB-NAAT test was positive. Sacroiliac joint aspiration sample was positive for CB-NAAT. The patient was administered with antituberculous drugs after which her symptoms began to subside and CXR was found to be normal on subsequent follow ups.Tuberculosis (TB) is one of the world’s most devastating infectious diseases caused by Mycobacterium tuberculosis, affecting nearly one-third of the world’s population.(1) India accounts for about 27% of total Global TB burden.(2) Tuberculosis of the musculoskeletal system, though accounts for only 1-3% of total TB cases,(3) of which approximately 10% occurs at the sacroiliac joint.[4-7]The majority of cases of hip TB presents as painful, restricted movements of the hip and there comes, the dilemma of accurate diagnosis as several pathologies may mimic this presentation.