A rare case of disseminated tuberculosis presenting as multiple visceral abscesses: retropharyngeal abscess, epidural abscess, pulmonary Koch’s, hepatic granuloma and splenic abscess
DOI:
https://doi.org/10.18203/2349-3291.ijcp20240102Keywords:
Retropharyngeal abscess in TB, Extrapulmonary TB, Multiple visceral abscess in disseminated TBAbstract
Extrapulmonary TB can present with plethora of clinical signs and symptoms, the spectrum of which remains boundless. Retropharyngeal abscess, epidural abscess, splenic abscess, hepatic granuloma are rare presentations of extrapulmonary TB which requires paramount clinical expertise for diagnosis and timely management thereby preventing dangerous complications. Here is a case report of a 6 year old boy presenting with 2 months history of fever, neck pain and swelling, difficulty in swallowing solid food, restricted neck movements, weight loss and family history of TB contact. Examination revealed bilateral jugulodigastric (level I and II) cervical lymphadenopathy (around 2×2 cm), neck rigidity and a paramedian bulge over posterior pharyngeal wall (measuring 3×3 cm), the inferior extent of which was difficult to visualize on oral cavity examination. Patient was worked up keeping in mind the high possibility of TB, radiography and ultrasonography of neck confirmed the presence of retropharyngeal abscess. CECT neck, chest and abdomen was done to find the extent of lesion and to look any other evidence of tuberculosis which revealed presence of retropharyngeal abscess, epidural abscess, pulmonary Koch’s, hepatic granuloma and splenic abscess with features s/o tuberculosis. He was started on ATT on clinico-radiological basis, his abscess was drained and cheesy material and pus were sent for microbiological and histo-pathological examination, although microbiological evidence was non-contributory, histopathology confirmed tuberculous retropharyngeal abscess. This case reporting was done to elicit the rare presentation of EPTB and the need of high degree of clinical suspicion for early diagnosis and timely treatment to prevent future complications.
References
Das A, Gupta V, Anupurba S. Rifampicin-Resistant Disseminated Tuberculosis in an Immunocompetent Adolescent Male Presenting with Retropharyngeal Abscess and Spinal Involvement. J Lab Physicians. 2021;13(3):277-9.
Garg RK, Somvanshi DS. Spinal tuberculosis: a review. J Spinal Cord Med. 2011;34(5):440-54.
WHO. Global Tuberculosis report. Geneva: WHO; 2022.
Harkani A, Hassani R, Ziad T, Aderdour L, Nouri H, Rochdi Y, et al. Retropharyngeal abscess in adults: five case reports and review of the literature. Scientif World J. 2011;11:1623-9.
Al-Hourani K, Al-Aref R, Mesfin A. Upper Cervical Epidural Abscess in Clinical Practice: Diagnosis and Management. Global Spine J. 2016;6(4):383-93.
Sahoo S, Naik S, Mishra B, Durgeshwar G, Panigrahi MK, Bhuniya S. Tuberculous splenic abscess in the immunocompetent host: a report and review of literature. Monaldi Arch Chest Dis. 2020;90(1).
Liu Y, Guo W, Gao S, Luo M, Liang K. A case of hepatic tuberculosis with acquired immune deficiency syndrome. Am J Med Sci. 2022;363(6):552-5.
Di Carlo C, Nardi S. On a retropharyngeal abscess caused by dorsal Pott's disease. Boll Mal Orecch Gola Naso. 1961;79:154-64.
Achouri M, Hilmani S, Lakhdar H, Ait Ben Ali S, Naja A, Ouboukhlik A, et al. Anterior approach of cervical spine in Pott's disease. Apropos of 7 cases. Rev Chir Orthop Reparatrice Appar Mot. 1997;83(5):447-53.
Benhammou A, Bencheikh R, Benbouzid MA, Boulaich M, Essakali L, Kzadri M. Cervical Pott's disease revealed by retropharyngeal abscesses. Rev Stomatol Chir Maxillofac. 2007;108(6):543-6.
Laretus VF. Retropharyngeal lymph nodes tuberculous adenitis in adult masked as retropharyngeal abscess. Vestn Otorinolaringol. 2000;(6):34-5.
Rao MJ, Gowda RS, Umapathy BL, Navaneeth BV. Tuberculosis of the parapharyngeal space: a rare case report. Indian J Pathol Microbiol. 2013;56(4):480-1.
Kooli H, Marreckchi M, Tiss M, Kooli M, Hajri H, Najeh D, et al. Cold parapharyngeal abscess in spondylodiscitis. Presse Med. 2001;30(1):19-21.
Amaya-Tapia G, Rodríguez-Toledo A, Aguilar-Benavides S, Aguirre-Avalos G. Large Retropharyngeal Abscesses in an Immunocompetent Adult Patient with Disseminated Tuberculosis. Am J Case Rep. 2016;17:690-3.
Hu X, Liu L. A huge retropharyngeal abscess causing airway and esophageal obstruction associated with cervical spine tuberculosis. Spine J. 2016;16(4):e227-9.
Bhargava SK, Gupta S. Large retropharyngeal cold abscess in an adult with respiratory distress. J Laryngol Otol. 1990;104(2):157-8.
Raza SN, Rahat ZM. Horner's syndrome as a co-presentation of tuberculous retropharyngeal abscess. J Coll Physicians Surg Pak. 2010;20(4):279-81.
Hasan GA, Kani SM, Alqatub A. Tuberculous lumbar spinal epidural abscess in a young adult (case report). SICOT J. 2018;4:5.
Sahoo S, Naik S, Mishra B, Durgeshwar G, Panigrahi MK, Bhuniya S. Tuberculous splenic abscess in the immunocompetent host: a report and review of literature. Monaldi Arch Chest Dis. 2020;90(1).
Fox E. Tuberculosis. In: Srickland GT, eds. Hunter's Tropical Medicine. 7th ed. Philadelphia: W. B. Saunders; 1991: 458-83.
Salem AH, Mallapa KK, Qaisaruddin S. Tuberculous abscess of the spleen. Trop Geogr Med. 1993;45(6):304-5.
Gotor MA, Mur M, Guerrero L, Aspiroz C, Romero D, Gimeno E. Tuberculous splenic abscess in an immunocompetent patient. Gastroenterol Hepatol. 1995;18(1):15-7.
Gallinger S, Strasberg SM, Marcus HI, Brunton J. Local hepatic tuberculosis, the cause of a painful hepatic mass: case report and review of the literature. Can J Surg. 1986;29(6):451-2.
Chien RN, Lin PY, Liaw YF. Hepatic tuberculosis: comparison of miliary and local form. Infection. 1995;23(1):5-8.
