ABSTRACT
Tuberculosis is one of the deadliest infectious disease. Its annual incidence was 10 million cases in 2019. We report the case of a 40 years old immunocompetent patient presenting with two large subcutaneous masses in his back. The diagnosis work-up will reveal multifocal tuberculosis with pulmmonary, vertebral, muscular and lymph node lesions. This case is unusual due to its presentation in an immunocompetent patient. Several laboratories have conducted experiments to isolate characteristics of the host that would allow the infection to spread despite the absence of an immunosuppressive medical condition. We also analyze the role of the PET scanner in the initial assessment and its interest in the monitoring of extra-pulmonary disease under anti-tuberculosis treatment. Multifocal tuberculosis cases are no longer the preserve of the immunocompromised and can be found in our industrialized countries. We must enonciate this diagnosis in front of unusual presentations. The delay in consultation, but also the delay of treatment, allows more widespread infections.
La tuberculose est une des maladies infectieuses les plus mortelles. Son incidence annuelle était de 10 millions de cas en 2019. Nous rapportons le cas d'un patient immunocompétent de 40 ans qui se présente avec deux volumineuses masses sous-cutanées au niveau du dos. La mise au point révélera une tuberculose multifocale avec une atteinte pulmonaire, vertébrale, ganglionnaire et des collections abcédées musculaires plurifocales. Ce cas est atypique de par sa présentation chez un patient immunocompétent. Plusieurs laboratoires ont essayé d'isoler des caractéristiques de l'hôte qui permettraient à l'infection une extension disséminée malgré l'absence de condition médicale immunodépressive. Nous analysons également le rôle du PET scanner dans le bilan initial et son intérêt dans le suivi des foyers extra-pulmonaires sous traitement anti-tuberculeux. Les cas de tuberculose multifocale ne sont plus l'apanage des patients immunodéprimés et peuvent se rencontrer dans les pays industrialisés. Le diagnostic doit pouvoir être évoqué devant des présentations atypiques. Le retard du diagnostic et de la prise en charge thérapeutique favorise des infections plus étendues.
Subject(s)
Tuberculosis , Humans , Adult , Tuberculosis/diagnosis , Tuberculosis/drug therapy , ImmunocompetenceABSTRACT
A 39-year-old healthy female patient with an unremarkable medical history complained about a rapidly progressive pain for a period of 1 month at the level of the anterior part of the right leg that was not relieved by NSAIDs. She mentioned only that she resumed her high level sport training 6 months before the onset of the symptoms. There was no specific history of trauma, fever, or other distinctive symptoms. On clinical examination, the right pretibial skin was inflamed and extremely painful. Walking became difficult the last 2 weeks. No skin injury was observed on the right leg and foot. The early blood tests, consistent with moderate aspecific inflammation, showed a slightly elevated C-reactive protein and sedimentation rate, without any leukocytosis. Upon first consultation the plain radiographs of the right leg were normal, but control radiographs obtained 2 weeks later showed cortical and lamellar lucencies of the right tibial crest.