Extrapulmonary tuberculosis, clinical presentation and outcome

OBJECTIVE: To identify patterns, features, and outcome of extrapulmonary tuberculosis in a tertiary care setting.

METHODS: A retrospective case-series was carried out of all cases diagnosed and treated as extrapulmonary tuberculosis during 1991 through to 2000 at King Faisal Specialist Hospital and Research Centre (KFSH and RC), Riyadh, Kingdom of Saudi Arabia. Demographic, clinical, laboratory, and outcome data were abstracted from medical records.

RESULTS: Over a 10-year period, 394 cases of extrapulmonary tuberculosis were diagnosed and treated at KFSH and RC. Isolated extrapulmonary tuberculosis was identified in 339 (86%) patients, 55 cases (14%) had both pulmonary and extrapulmonary tuberculosis. Mean age was 45-years, and 188 patients (47%) had co-morbidities, most commonly diabetes mellitus in 14.2% of patients. Laboratory confirmation of extrapulmonary tuberculosis was available on 386 patients. The most frequent site involvement was lymphadenopathy in 41% of the time. Chest x-ray was normal in 75% of patients. Among 298 patients with follow up data, 10 (3.4%) had documented relapse and 50 (16%) died. Death was related to tuberculosis in 24 (48%) patients.

CONCLUSION: A high level of clinical suspicion is essential for early diagnosis and treatment of extrapulmonary tuberculosis to reduce the significant morbidity and mortality.