TB or not TB? That is the question: A Complex Case with Potential TB Involvement

Abstract

Background: Tuberculosis (TB) and septic arthritis are common infectious diseases in Low- and Middle-Income Countries (LMICs). Septic embolism is a rare but can complicate these infections. We present a challenging case of a 13-year-old boy with septic arthritis and septic embolism, with a complex chest infection, highlighting diagnostic complexities and multidisciplinary management in a resource-constrained setting.

Case Presentation: The patient initially presented with a painful, swollen right lower limb, later developing respiratory symptoms. Imaging showed popliteal deep vein thrombosis (DVT), cellulitis, and multiple lung opacities. Lab findings indicated methicillin-resistant Staphylococcus aureus (MRSA), acute kidney injury, and extensive antibiotic resistance. Despite multiple antibiotic regimens and surgical interventions, his condition worsened, culminating in tension pneumothoraxes and cavitating lung lesions. Owing to financial constraints and persistent clinical deterioration, empirical anti-TB therapy was started despite negative TB investigations. He improved rapidly, was weaned off oxygen, and eventually discharged.

Discussion: This case presented diagnostic challenges, with negative TB tests despite a strong clinical suspicion. Multidisciplinary collaboration was pivotal in decision-making, emphasizing the necessity of adaptive treatment strategies: the patient's atypical presentation and potential environmental factors, such as chronic smoke exposure, raised queries. Financial constraints impacted diagnostic choices necessitating frequent antibiotic regimen changes.

Conclusion: This complex case underscores the significance of a multidisciplinary approach and adaptive treatment strategies particularly in resource-limited settings. It emphasizes the importance of considering all factors influencing the initiation of anti-TB treatment when faced with recurrent negative TB results. Furthermore, it highlights the influence of financial constraints on diagnostic methods and medication regimens in managing such cases.