Disseminated tuberculosis in an immunocompetent young female: a case report from Indonesia and a literature review

Disseminated TB is a potentially life-threatening condition which usually affects immunocompromised patients.

This is a case report of a 40-year-old immunocompetent female presenting with disseminated tuberculosis (TB) involving the lungs, central nervous system, spleen, and lymph nodes. The patient reported a month-long history of diplopia, particularly affecting her right eye, along with vertigo, weight loss, headache, and cough. A history of tuberculous lymphadenopathy and pulmonary tuberculosis treated a year prior was noted, though follow-up confirmation was incomplete. Clinical examination revealed right-sided seventh cranial nerve palsy and slightly elevated intraocular pressure. Laboratory tests revealed anemia, elevated erythrocyte sedimentation rate, low iron levels, and positive antinuclear and anti-Toxoplasma antibodies. Chest imaging showed miliary nodules in the lungs, while a computed tomography scan identified splenic granulomas. Magnetic resonance imaging of the brain revealed a ring-enhancing lesion, pachymeningeal thickening, and arterial wall enhancement, suggestive of tuberculoma, tuberculous meningitis, and vasculitis. Despite negative Mycobacterium tuberculosis cultures, cerebrospinal fluid analysis indicated low glucose and elevated protein, and a line probe assay confirmed the presence of Mycobacterium tuberculosis. The patient was then treated with complete tuberculosis. Significant clinical improvement was observed within a month, and treatment continued for 11 months.

This case highlights the rare occurrence of disseminated TB in an immunocompetent individual and underscores the importance of early diagnosis and management to prevent severe complications.