Mycobacterium tuberculosis: sometimes, a hidden culprit.

1 of 2 DESCRIPTION A previously healthy 31-year-old woman presented to our emergency department with a 1-month history of fever, non-productive cough, malaise and weight loss. She also reported having had low back and left buttock pain for the last 5 months. Stress tests of the sacroiliac joint, namely the lateral pelvic compression test, the fl exion, abduction and external rotation of the hip joint test and the Gaenslen ́s test (hyperextension of the hip with pelvis fi xed by fl exion of opposite hip and knee) were positive, that is, they elicited pain on the left sacroiliac joint. Chest radiography performed on admission showed multiple, faint small nodules in both lungs ( fi gure 1A ). A subsequent fundus examination revealed a greyishwhite oblong patch with indistinct edges in the right eye ( fi gure 1B ), which was ascribed to choroidal tubercle by an ophthalmologist. MRI showed signs of left sacroiliitis with accompanying iliopsoas abscess ( fi gure 1C ). The histopathological analysis of the bone marrow biopsy samples from the right iliac crest revealed multiple caseating granulomas with Langhan ́s-type giant cells ( fi gure 1D ). Tuberculin skin test and serology for the human immunodefi ciency virus were negative. Specimens from bronchioalveolar lavage fl uid, transbronchial biopsy, urine, blood and bone marrow biopsy were negative for acidfast bacilli as well as for Mycobacterium tuberculosis culture and PCR testing. Considering that there was no evidence for other alternative aetiology, disseminated tuberculosis was diagnosed on the basis of miliary chest pattern, choroidal lesion and pathological fi ndings. The patient was treated with antituberculous drugs for 9 months. She had a full clinical and radiological recovery. Disseminated tuberculosis is uncommon, especially in immunocompetent patients. 1 The broad spectrum of its Images in...