An Unusual and Rare Presentation of Extra-Pulmonary Tuberculosis

The clinical manifestations of tuberculosis are of two types: Pulmonary and Extra-pulmonary forms of Tuberculosis (EPTB), the former being the commonest. In EPTB highly vascular areas such as lymph nodes, meninges, kidney, spine and growing ends of the bones are commonly affected. The other sites are pleura, pericardium, peritoneum, liver, gastro-intestinal tract, genito-urinary tract and skin. EPTB is defined as TB of organs other than the lungs, such as pleura, lymph nodes, abdomen, genito-urinary tract, skin, joints, bones, tubercular meningitis, tuberculoma of the brain, etc. Diagnosis is based on one culture-positive specimen from the extra-pulmonary site; or histological evidence; or strong clinical evidence consistent with active EPTB disease followed by a medical officer's decision to treat with a full course of anti-TB therapy. Here, in this paper we describe the different manifestations of Extra-pulmonary tuberculosis within three family members living under the same roof in Chennai, Tamil Nadu, India. The patient who presented to us was a 45 year old woman who was found to have a tuberculous compound palmar ganglion; which was excised and started on antituberculous drugs. On evaluation of her history it was found that her son, aged 24 was diagnosed with intestinal obstruction four years back. He was evaluated with CECT and colonoscopy and was found to have multiple polypoid lesions along with luminal narrowing at the level of the sigmoid colon. He underwent resection of the sigmoid colon leaving a 5cm margin on either side with primary end to end anastomosis. The resected specimen was sent for HPE and was confirmed to be of tuberculous pathology. He was further treated with ATT; is on regular follow up and is doing well. Further enquiry also revealed that her husband had been diagnosed with pulmonary tuberculosis 15 years back for which he took medication only for 3 months and discontinued the medication thereafter since he felt symptomatically better.