"Mistaken" a case report of a 15-year old male with an atypical presentation of extrapulmonary tuberculosis / Czarinnah Elaine F. Dy and Maria Anna P. Bañez.

Includes appendices and bibliographical references.

Abstract: Among Filipinos, tuberculosis (TB) remains to be a major health problem. Abdomen is one of the major extrapulmonary sites. Despite its prevalence, non- specific clinical presentation leads to a delay in the diagnosis. A high index of clinical suspicion is required since it mimics other diseases. We present a male adolescent with an atypical presentation of extrapulmonary TB. Patient had 14-month history of fever at night, chills nighttime diaphoresis and gradual abdominal distension, 12-month history of gradual weight loss, 3-month history of umbilical discharge and, 1-month history of on and off watery-based stools. Physical examination revealed BMI of 16.7 (underweight), pallor, foul-smelling, purulent umbilical discharge, abdominal tenderness on the right upper and lower quadrant areas and palpable liver and spleen. On investigation, Mantoux skin test was 23 mm and GeneXpert of umbilical discharge revealed Mycobacterium tuberculosis without rifampicin resistance, hence a diagnosis of abdominal tuberculosis. In addition, right suprahilar lymphadenopathy was seen on chest x-ray, hence a consideration of mediastinal lymph node TB as well. Contrast-enhanced whole abdomen CT scan with fistulogram revealed an umbilical fistulous communication to a complex fluid collection in the abdominopelvic region extending into the perihepatic region. Peritoneal caking, splenomegaly, enlarged mesenteric lymph nodes and minimal ascites were noted. CT-guided percutaneous drainage of the abdominopelvic abscess was initially done and was converted to a pigtail catheter insertion due to the viscosity of the fluid. Patient was treated with anti-Koch's medications for 6 months, which offered resolution of symptoms and weight gain that reached a normal BMI.

Research - Department of Child Health