Isolated Forearm Abscess with Bilateral Psoas Abscesses: An Unusual Presentation of Extrapulmonary Preextensively Drug-resistant Tuberculosis without Pulmonary Involvement.
Sanjay Gabhale, Balamoni Vinay Kumar Goud, Sai Karthik Guniganti
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Case in brief
An immunocompetent 16-year-old girl presented with right-sided chest pain, an enlarging left forearm swelling, anorexia, and weight loss, without fever, cough, night sweats, or known TB contact. Imaging showed a forearm abscess, bilateral psoas collections, and lumbosacral vertebral destruction with paravertebral involvement consistent with Pott’s disease; chest radiography was unremarkable. GeneXpert testing of pus identified M. tuberculosis complex with rifampicin resistance, and line-probe testing found additional isoniazid and fluoroquinolone resistance, meeting the definition of pre-XDR TB. She received an all-oral modified longer regimen and had steady clinical recovery.
What made this case unusual
The combination of a forearm abscess, bilateral psoas collections, and spinal involvement from pre-XDR TB occurred without radiographic pulmonary disease, despite the absence of typical constitutional or respiratory symptoms.
Diagnostic / clinical pearl
TB should remain in the differential for abscesses at atypical soft-tissue sites, even when chest imaging is clear. Molecular testing of aspirated pus can identify TB and drug resistance to guide appropriate therapy.