Primary Isoniazid Mono-Resistant Extrapulmonary Tuberculosis Presenting as Cervical Lymphadenitis: The World's First Case of Its Type

Tuberculous Pericardial Effusion With Pleural Effusion in an Indian Female: A Rare Case

Tuberculosis can present at various extrapulmonary sites. However, even in endemic countries, concomitant involvement of different sites in the same patient is rarely reported. Further, tuberculous pericarditis represents a fraction of all tuberculosis infections and is an uncommon form of extrapulmonary tuberculosis. In underdeveloped nations, it is the most frequent cause of massive pericardial effusion. Additionally, it is the most common cause of constrictive pericarditis in adults, which has a high death rate and a poor prognosis. Furthermore, concomitant pleural effusion due to Mycobacterium tuberculosis is infrequently reported. Herein, a case of concomitant pericardial and left-sided pleural effusion in an Indian female is reported. She came with complaints of breathlessness, chest pain, night sweats, and loss of appetite. A diagnostic pleural thoracentesis and pericardiocentesis helped establish the diagnosis, and she was commenced on antituberculous treatment for 168 days.

Primary Rifampicin Mono-Resistant Tuberculosis of the Cervical, Mediastinal, and Axillary Lymphadenopathy in an Indian Male: A First-of-Its-Type Case

Tuberculosis is common in endemic countries. However, extrapulmonary tuberculosis is relatively rare, and primary extrapulmonary rifampicin mono-resistant tuberculosis of the cervical, mediastinal, and axillary lymph nodes simultaneously without pulmonary focus in an immunocompetent male has never been reported. Herein is a case of a 27-year-old Indian male with no previous history of tuberculosis who was diagnosed after an extensive clinical assessment with a radiometric and cartridge-based nucleic acid amplification assay of the swollen lymph nodes. He was put on antituberculous treatment per the all-oral longer regimen of the national program.

Musculoskeletal Tuberculosis of the Pectoralis With Bilateral Pleural Base Nodular Lesions: A Rare Report of Its Type in an Immunocompetent Female

Musculoskeletal tuberculosis is a rare infection caused by Mycobacterium tuberculosis. This type of extrapulmonary tuberculosis is mainly attributed to hematogenous infection or direct inoculation and is usually seen in immunocompromised individuals. Here, a case of musculoskeletal tuberculosis of the right pectoralis with bilateral pleural base nodular lesions in an immunocompetent female is presented. A challenging diagnosis was achieved through a detailed clinical examination, aspiration of the pus, and radiometric investigations. Management was done through antituberculous chemotherapy per the national guidelines. Further, a detailed literature review revealed that tuberculosis of the pectoralis with bilateral pleural base nodular lesions is never reported in an immunocompetent female.

Primary Rifampicin Mono-Resistant Extrapulmonary Tuberculosis of the Knee Without Pulmonary Involvement: One of the First Cases of Its Type in an Immunocompetent Male

Tuberculosis presentation at sites other than the lungs is relatively infrequent, and isolated knee involvement without a pulmonary focus is exceptionally rare. Furthermore, there have been no reported cases of primary rifampicin mono-resistant extrapulmonary tuberculosis of the knee in males. In this case, a 24-year-old male patient presented with pain and swelling in his left knee after a fall five years ago. Given the absence of a history of tuberculosis, arriving at a diagnosis posed a significant challenge. However, the diagnosis was ultimately established through cartridge-based nucleic acid amplification tests and clinical link-up with radiometric techniques. Management was based on the latest national guidelines for anti-tuberculous treatment, which were tailored to his weight. To date, he has completed nine months of treatment with a significant improvement in his symptoms. This rare presentation emphasizes the need for a high degree of suspicion even in extrapulmonary tuberculosis cases.

Primary Extrapulmonary Rifampicin Mono-Resistant Tuberculosis of the Knee in an Indian Female Without Pulmonary Involvement: The World's First Case

Extrapulmonary tuberculosis presentations are comparatively less frequent. Isolated involvement of the knee in the absence of pulmonary focus is extremely rare. Further, primary extrapulmonary rifampicin mono-resistant tuberculosis of the knee without pulmonary involvement is never reported in females. A case of a 26-year-old female is presented who came with complaints of pain, swelling, and discharging sinuses from her left knee. In the absence of a history of tuberculosis or trauma, the diagnosis was challenging. However, she was diagnosed based on the reports of cartridge-based nucleic acid amplification tests and clinical correlation with radiometric techniques and initiated anti-tuberculous treatment according to her weight per the national guidelines present in 2018.

Isoniazid Mono-Resistant Tuberculosis Presenting as Empyema Thoracis With Citrobacter koseri and Morganella morganii Infections: The World's First Reported Case of Its Type

Drug resistance is very common in developing countries. Isolated cases of concomitant infection with Mycobacterium tuberculosis, Citrobacter koseri, and Morganella morganii are rare. Furthermore, there is no report available in the literature of concurrent infection of Citrobacter koseri and Morganella morganii in an isoniazid mono-resistant tuberculosis patient. In this case, we present a concomitant infection with drug-resistant strains of Mycobacterium tuberculosis, Citrobacter koseri, and Morganella morganii in a 40-year-old Indian male who presented with fever, dry cough, and chest pain. He was initiated on an isoniazid mono regimen and a broad-spectrum antibiotic, following the national guidelines.