Recurrent Tuberculous Cold Abscesses of Unknown Source in an Immunocompetent Young Male: Case Report and Review of Literature.

INTRODUCTION: Tuberculous Cold Abscesses (TCA) are localized collections of Mycobac-terium tuberculosis infection, typically lacking overt signs of inflammation. While common in en-demic areas, recurrent TCAs in immunocompetent individuals without pulmonary tuberculosis are exceedingly rare and present significant diagnostic and therapeutic challenges. Poverty, malnutrition, and unclean living standards may indirectly contribute to the recurrence of TCA. Based on our extensive research using PubMed and Google, the present case is unique and the only documented case of this type.

CASE PRESENTATION: We report the case of an 18-year-old immunocompetent male from Uttar Pradesh state, India, who developed recurrent tuberculous cold abscesses at different anatomical sites over four years. The first episode presented as a cervical abscess and was microbiologically confirmed by acid-fast bacilli staining and Cartridge-Based Nucleic Acid Amplification Test (CBNAAT). Despite standard Antitubercular Therapy (ATT) and complete clinical resolution, he subsequently developed three further episodes involving distinct sites: right supraclavicular region, left paraspinal region, and right infra-axillary region. Each episode demonstrated microbiological evidence of Mycobacterium tuberculosis without rifampicin resistance. Repeat serological testing confirmed preserved immune competence. Management included ultrasound-guided aspiration combined with ATT as per National Tuberculosis Elimination Program (NTEP) guidelines. One episode was complicated by hepatotoxicity, necessitating regimen adjustment. Each abscess eventually resolved following prolonged ATT courses, and no residual collection was noted on imaging during follow-up.

CONCLUSION: This case highlights the rare entity, as there was no underlying detected primary focus and no immunocompromised status. Early microbiological diagnosis, appropriate drainage, strict adherence to ATT, and vigilant follow-up are essential to prevent recurrence and ensure complete resolution. Clinicians must maintain a high index of suspicion, particularly in tuberculosis-endemic regions.