Disseminated Tuberculosis in an Immunocompetent Patient

Abstract Disseminated Mycobacterium tuberculosis (Mtb), where the infection spreads beyond the lungs, is rare in immunocompetent individuals. Disseminated Mtb can affect organs, such as the liver, brain, and bone marrow, and often mimics other diseases, such as fungal infections or cancer. While factors like HIV or immunosuppression increase the risk of Mtb spread, diagnosing disseminated Mtb is challenging because of nonspecific symptoms and limitations in testing. This case study involves a 74-year-old man with no major risk factors for Mtb. He presented with abdominal pain, weight loss, and gastrointestinal issues but later developed lung and neurological symptoms. Initial tests were inconclusive, but Mtb was eventually confirmed after positive quantiferon testing and culture results from ascitic and lung fluid. Despite treatment with RIPE therapy (rifampin, isoniazid, pyrazinamide, ethambutol), the patient died. The case highlights the complexities of diagnosing Mtb, especially when typical tests are inconclusive. Cytokine abnormalities, such as elevated interleukin-2 receptor levels, may be helpful markers for diagnosis and prognosis, particularly in Mtb meningitis (tuberculous meningitis). This discussion emphasizes the importance of considering Mtb in cases of unexplained multiorgan failure and the need for timely Mtb culture and treatment.