Skip to main content
NCBI home page
The Western Journal of Medicine logoLink to The Western Journal of Medicine
. 1977 Apr;126(4):253–262.

The Spectrum of Extrapulmonary Tuberculosis

Ahmet Baydur
PMCID: PMC1237539  PMID: 855317

Abstract

The incidence of new cases of extrapulmonary tuberculosis has remained constant, despite the decline in new cases of active pulmonary tuberculosis. This might be due to a delay in recognition, and particularly a lack of consideration of tuberculosis when the presenting symptoms are other than respiratory. Extrapulmonary tuberculosis should be considered in the differential diagnosis of bone, joint, genitourinary tract and central nervous system (CNS) diseases.

To determine factors that might delay recognition and identification, 62 patients having extrapulmonary tuberculosis during 1969-1972 at the Los Angeles County-University of Southern California Medical Center were studied.

Three quarters of these patients had had CNS, skeletal or genitourinary tuberculosis in equal distribution or 25 percent each. CNS involvement was seen frequently in the disseminated form. Presenting symptoms were protean and not specific, such as fever, anorexia, weight loss, cough, lymphadenopathy and neurologic abnormalities. Roentgenograms of the chest were abnormal in most. When a roentgenogram of the chest suggests pulmonary tuberculosis, signs and symptoms in other body systems should suggest extrapulmonary tuberculosis. If no abnormalities are seen on a roentgenogram of the chest, however, this does not preclude the diagnosis of extrapulmonary tuberculosis. Neither does a negative tuberculin skin test exclude the condition.

Abnormal laboratory findings are common, especially in disseminated tuberculosis. These include various anemias, bone marrow disorders, hyponatremia due to inappropriate antidiuretic hormone syndrome. Analyses of pleural, peritoneal, pericardial and joint fluid usually show an exudate high in lymphocytes and occasionally low in glucose. Similar findings are seen in spinal fluid. The histological features of caseous or noncaseous granulomas are suggestive of but not specific for tuberculosis. Only culture of mycobacteria from sputum, urine, spinal fluid, pleural and other effusions and tissue biopsy specimens will yield a definitive diagnosis.

Physicians must have a high index of suspicion to diagnose extrapulmonary tuberculosis, as it can resemble any disease in any organ system. Immediate therapy in the disseminated variety, sometimes even before a definite diagnosis can be made, may be lifesaving.

Full text

PDF
253

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BIEHL J. P. Miliary tuberculosis; a review of sixty-eight adult patients admitted to a municipal general hospital. Am Rev Tuberc. 1958 Apr;77(4):605–622. doi: 10.1164/artpd.1958.77.4.605. [DOI] [PubMed] [Google Scholar]
  2. Berger H. W., Mejia E. Tuberculous pleurisy. Chest. 1973 Jan;63(1):88–92. doi: 10.1378/chest.63.1.88. [DOI] [PubMed] [Google Scholar]
  3. Borhanmanesh F., Hekmat K., Vaezzadeh K., Rezai H. R. Tuberculous peritonitis. Prospective study of 32 cases in Iran. Ann Intern Med. 1972 Apr;76(4):567–572. doi: 10.7326/0003-4819-76-4-567. [DOI] [PubMed] [Google Scholar]
  4. CARR D. T., POWER M. H. Pleural fluid glucose with special reference to its concentration in rheumatoid pleurisy with effusion. Dis Chest. 1960 Mar;37:321–324. doi: 10.1378/chest.37.3.321. [DOI] [PubMed] [Google Scholar]
  5. Cameron S. J. Tuberculosis and the blood--a special relationship? Tubercle. 1974 Mar;55(1):55–72. doi: 10.1016/0041-3879(74)90067-1. [DOI] [PubMed] [Google Scholar]
  6. Christensen W. I. Genitourinary tuberculosis: review of 102 cases. Medicine (Baltimore) 1974 Sep;53(5):377–390. doi: 10.1097/00005792-197409000-00004. [DOI] [PubMed] [Google Scholar]
  7. GIERSON H. W., OWENS G. J. Chloride content of the cerebrospinal fluid. Calif Med. 1961 Feb;94:77–78. [PMC free article] [PubMed] [Google Scholar]
  8. Gelb A. F., Leffler C., Brewin A., Mascatello V., Lyons H. A. Miliary tuberculosis. Am Rev Respir Dis. 1973 Dec;108(6):1327–1333. doi: 10.1164/arrd.1973.108.6.1327. [DOI] [PubMed] [Google Scholar]
  9. Holden M., Dubin M. R., Diamond P. H. Frequency of negative intermediate-strength tuberculin sensitivity in patients with active tuberculosis. N Engl J Med. 1971 Dec 30;285(27):1506–1509. doi: 10.1056/NEJM197112302852704. [DOI] [PubMed] [Google Scholar]
  10. Marcq M., Sharma O. P. Tuberculosis of the spine: a reminder. Chest. 1973 Mar;63(3):403–408. doi: 10.1378/chest.63.3.403. [DOI] [PubMed] [Google Scholar]
  11. Munt P. W. Miliary tuberculosis in the chemotherapy era: with a clinical review in 69 American adults. Medicine (Baltimore) 1972 Mar;51(2):139–155. doi: 10.1097/00005792-197203000-00004. [DOI] [PubMed] [Google Scholar]
  12. Myers J. A. The natural history of tuberculosis in the human body; forty-five years of observation. JAMA. 1965 Dec 6;194(10):1086–1092. [PubMed] [Google Scholar]
  13. RUSSAKOFF A. H., LEMAISTRE C. A., DEWLETT H. J. An evaluation of the pleural fluid glucose determination. Am Rev Respir Dis. 1962 Feb;85:220–223. doi: 10.1164/arrd.1962.85.2.220. [DOI] [PubMed] [Google Scholar]
  14. Sahn S. A., Neff T. A. Miliary tuberculosis. Am J Med. 1974 Apr;56(4):494–505. doi: 10.1016/0002-9343(74)90482-3. [DOI] [PubMed] [Google Scholar]
  15. Sbarbaro J. A. Tuberculosis: the new challenge to the practicing clinician. Chest. 1975 Sep;68(3 Suppl):436–443. doi: 10.1378/chest.68.3_supplement.436. [DOI] [PubMed] [Google Scholar]
  16. Snider D. E., Jr Extrapulmonary tuberculosis in Oklahoma, 1965 to 1973. Am Rev Respir Dis. 1975 May;111(5):641–646. doi: 10.1164/arrd.1975.111.5.641. [DOI] [PubMed] [Google Scholar]

Articles from Western Journal of Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES