Atypical disseminated tuberculosis with multi-organ involvement and secondary infertility in an immunocompetent female: a case report and review of the literature

Introduction and importance: Tuberculosis (TB), caused by Mycobacterium tuberculosis , is a widespread infection. While typically affecting the lungs, 10%–20% of cases involve extrapulmonary sites. Disseminated TB with involvement of multiple contiguous or non-contiguous organs is a rare phenomenon. Presentation of case: A 28-year-old female from Garbo, Ethiopia, presented with a 1-year history of lower back pain and chronic pelvic pain, amenorrhea, and secondary infertility. She also reported 6 months of progressive left middle finger swelling and constitutional symptoms. Examination revealed a chronically ill and tenderness in her left middle finger and lower back. Investigations showed mild iron deficiency anemia. X-rays of the left hand and lumbosacral region, along with abdominopelvic ultrasound, revealed osteomyelitis of the finger and lumbar endplate destruction with bilateral psoas abscesses. Aspirate from the psoas abscess was positive for M. tuberculosis by GeneXpert. The patient was treated with 2RHZE/10RH and showed improvement. Clinical discussion: Disseminated TB presents with varied symptoms and affects different sites outside the lungs. Rare in immunocompetent individuals, risk factors include malnutrition, malignancy, retroviral infection, substance abuse, and extremes of age. Lymphohematogenous spread is common. Disseminated TB can affect any organ system, and it rarely presents with the involvement of multiple organs simultaneously, as seen in our patient. Diagnosis relies on organ-specific imaging and bacteriological confirmation. Treatment adheres to updated World Health Organization and national guidelines to improve patient outcomes. Conclusion: Disseminated TB is rare but requires prompt diagnosis and treatment. Resource limitations hinder diagnosis and management, necessitating community awareness and infrastructure improvements.