Multifocal Tuberculosis Revealed by Cutaneous Abscesses in an Immunocompetent Patient

Abstract

Multifocal tuberculosis (MTB) is defined as the involvement of two or more non-contiguous extrapulmonary sites, with or without associated pulmonary TB. It is a rare and severe form, accounting for only 10% of extrapulmonary TB cases. Multifocal TB can affect immunocompetent individuals. Its varied presentation can mislead clinicians, emphasizing the need for a thorough assessment of TB dissemination. This study presents the case of 26-year-old male who had a year-long history of pelvic and spinal pain, without signs of enthesitis or peripheral involvement. Bone biopsy confirmed granulomatous tuberculoid inflammation without necrosis, strongly suggesting multifocal tuberculosis (bone and skin). The patient received anti-tuberculosis treatment with rifampicin, isoniazid, pyrazinamide, and ethambutol for two months, followed by rifampicin and isoniazid alone to complete a 12-month course. Presentation of multifocal tuberculosis is rare but is possible in the immunocompetent host; thus, it should be kept in the differential diagnosis even in the absence of immunosuppression. Imaging and histopathological studies aid in confirming the diagnosis allowing for early and appropriate anti-tuberculosis treatment. The case presented illustrates the importance of considering broad differential diagnoses when managing some atypical and disseminated infections.