Unusual sites of tuberculosis in patients with rheumatologic conditions

ABSTRACT

INTRODUCTION: Tuberculosis (TB) is a chronic infectious disease, with a growing incidence seen worldwide. Among the tuberculous infections, pulmonary TB remains to be the most common, with extrapulmonary TB seen in only less than 2.0% of this population. Although the latter remains to be rare, it is commonly found in the lymph nodes, gastrointestinal (GI) and genitourinary (GU) tracts, weight- bearing joints, and the meninges. But, however rare extra- pulmonary tuberculosis may be, some patients have reported the occurrence of such in less common sites.In patients with autoimmune diseases, the diagnosis and management of microbial infections remain complicated because of their immunocompromised nature, and because of the medications they receive. As tuberculosis is a curable disease, early identification and proper treatment should be applied to avoid further patient compromise.OBJECTIVE: The objective of this paper is to present three cases of patients diagnosed with extrapulmonary tuberculosis at atypical sites namely tuberculous cellulitis, endometrial tuberculosis, and tuberculous dactylitis, accompanying a primary rheumatologic disease.CASES Case 1 is a patient with Dermatomyositis who presented with pain and non- traumatic ecchymosis on his right gluteus, later diagnosed as TB cellulitis through a positive AFB smear of the aspirate. Case 2 is a patient with SLE whose amenorrhea was initially attributed to Cyclophosphamide. However, further work up revealed tuberculous bacteria through AFB smear of the curetting, hence was diagnosed with Endometrial TB. Case 3 reports another patient with SLE, who was diagnosed with recurrent TB dactylitis through a positive AFB smear of the biopsy.CONCLUSION: Despite the high endemicity of the Philippines for tuberculosis, extra- pulmonary TB continues to be underrecognized. Patients with autoimmune conditions are most likely to suffer from such infections due to their immunocompromised state. High suspicion and management remain to be the cornerstone to avoid diagnostic delays, and improve outcome.