Late diagnosis of disseminated tuberculosis: A case report

INTRODUCTION The lungs are most commonly involved in tuberculosis, but infection can involve other organs through lymphohematogenous dissemination. The clinical presentation of disseminated tuberculosis is variable. Diagnosis is challenging as 50% of patients present a late diagnosis because clinical manifestations are diverse and subacute, and microbiological testing relies on invasive procedures for mycobacterial culture and supportive histopathology CASE REPORT A 30-year-old male patient, deprived of his liberty, with no co-morbidities, was admitted to the hospital for severe pain in the left wrist, with a previous history of having received systemic glucocorticoids for seven months. He developed clinical symptoms of pulmonary tuberculosis in the pleura, in the joint of the left wrist, and the left testicle and tests confirmed the presence of M. tuberculosis. He underwent surgery on the wrist and testicle and was also treated for susceptible tuberculosis. Concomitant sequelae of iatrogenic Cushing's disease, chronic anemia, and chronic inactive proctitis were diagnosed. CONCLUSIONS Diagnosing disseminated tuberculosis was challenging due to the non-specific clinical picture, limitations of confirmatory diagnostic tools, and timely specialized evaluations. Prolonged use of systemic corticosteroids may have played a role in the dissemination of tuberculosis.