1. Extrapulmonary tuberculosis
Varied presentation
Difference in management

2. Tuberculosis
Can affect any organ
~85% pulmonary
Rest extrapulmonary

3. Standard ATT
HRZE2/HR4
unless otherwise specified

4. Tuberculous lymphadenitis
 Commonest extrapulmonary site
 Children & young adults
 Cervical LN involvement- commonest
 Firm discrete or matted lymph nodes
 Occasionally abscess or sinus
 Dx- FNAC or biopsy
 Rx- standard ATT
 Surgery- rarely required

5. Pleural-Pericardial-Peritoneal TB
 Pleural TB causes pleural effusion
 Pericardial TB- effusionconstriction
 Peritoneal TB- ascitis, abdominal pain
 Symptoms- non-specific- fever, cough, chest
pain, SOB, abdominal swelling
 Signs-
 pleural effusion
 pericardial tamponade/constrictive pericarditis
 ascitis

6. Pleural-Pericardial-Peritoneal TB
 Ix- X-ray, ECG, ultrasound
 Dx- pleural/pericardio/paracentesis-
 exudative fluid with lymphocytosis
 Fluid ADA- increased
 AFB smear & culture
 Biopsy, if required
 Rx- standard ATT
 Steroids in pericardial TB

7. Tuberculous meningitis
 Mainly basal, with cranial nerve defects &
hydrocephalus due to obstruction of ventricular
system
 May cause arteritisinfarction
 Symptoms- headache, fever, seizures,
altered sensorium, III/VII/VIII nerve palsy
 Neck stiffness with Kernig’s/Brudzinski sign +ve
 Dx- CSF lymphocytosis, raised protein, low glucose,
CT/MRI, AFB/culture +ve
 Rx- 18 months of ATT, with steroids x 3 months
 Surgery for hydrocephalus
 ~25% have residual sequelae

8. CNS TB
 Tuberculoma
 Intracranial SOL
 Thick ring-enhancing lesion ± cavitation on CT
 Dx- empirical or biopsy
 Rx- ATT x 9-12 months
 Surgery for mass effect
 Follow-up with serial CT scans
 Vasculitis
 Causes ischemia

9. GI TB
 Involves any part of GIT
 Commonest- ileocecal area
 Causes fever, abdominal pain, hematochezia,
diarrhea/constipation, RLQ mass
 Dx- endoscopy with biopsy, CT scan,
barium meal follow-through/enema
 Rx- standard ATT
 Complication- obstruction, perforation, fistula
 Surgery required for complications

10. Skeletal TB
 Pott’s spine-
 Lower thoracic/lumbar spine commonly involved
 May involve contiguous vertebrae with disc involvement
 Cold abscess is usually bilateral
 Can lead to vertebral collapse with spinal instability, gibbous
deformity & spinal cord compression
 Arthritis-
 Mostly monoarticular
 Hip joint most commonly involved
 Slowly progressive destruction of joint
 Osteomyelitis- cold abscess of any bone

11. Skeletal TB
 Dx- X-ray, MRI, microscopy & culture of
infected material
 Rx- ATT for 12-24 months
 Surgery-
 Diagnostic
 Abscess drainage
 Debridement of infected material
 Decompression & stabilization of spinal cord
 Follow-up- best clinically- pain, constitutional
symptoms, mobility, neurologic improvement

12. Genitourinary TB
 Renal TB- dysuria, hematuria, flank pain
 Male genital tract- scrotal mass, oligospermia
 Female genital tract- pelvic pain, bleeding PV,
blocked fallopian tube
 Dx- urine exam/culture, biopsy, CT
scan, IVP (papillary necrosis, HDN)
 Rx- standard ATT
 Corrective surgery

13. Miliary TB
 Hematogenously disseminated
 More common in immunocompromised
 Symptoms- non-specific
 Sign- choroidal tubercle on retinal exam
 Dx- CxR- miliary tubercles
 Rx- standard ATT