{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T22:03:57Z","timestamp":1759010637096,"version":"3.44.0"},"reference-count":9,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>A 40-year-old manual labourer presented with easy fatiguability, recurrent vomiting and loss of weight of 3\u2005months, duration. Upon examination, there was significant axillary and cervical lymphadenopathy. No pallor, icterus or clubbing was evident. There was generalised hyperpigmentation and multiple oral ulcers. The blood pressure 90\/60\u2005mm\u2005Hg in the right upper limb in the supine position. Investigations showed a low serum cortisol. Mantoux test was strongly positive (20\u2005mm).A fine needle aspiration biopsy of the cervical lymph node revealed reactive changes. Bone marrow aspiration and biopsy were normal. Cervical lymph node biopsy showed caseating granulomas suggestive of tuberculous lymphadenitis. A CT scan of the abdomen showed bilaterally enlarged adrenal glands with hypodense areas suggestive of necrosis. He was diagnosed with extrapulmonary disseminated tuberculosis with tuberculous adrenalitis. He was started on directly observed therapy (DOTS) for disseminated tuberculosis and 40\u2005mg of prednisolone. He is improving with treatment.<\/jats:p>","DOI":"10.1136\/bcr-2012-008011","type":"journal-article","created":{"date-parts":[[2013,5,18]],"date-time":"2013-05-18T00:32:42Z","timestamp":1368837162000},"page":"bcr2012008011","source":"Crossref","is-referenced-by-count":2,"title":["Extrapulmonary disseminated tuberculosis with tuberculous adrenalitis: a stitch in time saves nine"],"prefix":"10.1136","volume":"2013","author":[{"given":"Chandrasekharan","family":"Rajasekharan","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Medical College Hospital, Thiruvananthapuram, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sivasankarannair","family":"Ajithkumar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, SUT Medical College Hospital, Thiruvananthapuram, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Varghese","family":"Anto","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Government Medical College, Thiruvananthapuram, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajasekharan","family":"Parvathy","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, MOSC Medical College, Ernakulam, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2013,5,17]]},"reference":[{"key":"2025082703200118000_2013.may17_1.bcr2012008011.1","first-page":"690","article-title":"New vision for Revised National Tuberculosis Control Programme (RNTCP): Universal access\u2014\u2018Reaching the un-reached","volume":"2013","author":"Sachdeva","year":"2012","journal-title":"Indian J Med Res"},{"key":"2025082703200118000_2013.may17_1.bcr2012008011.2","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1056\/NEJM199610173351607","article-title":"Adrenal insufficiency","volume":"2013","author":"Oelkers","year":"1996","journal-title":"N Engl J Med"},{"key":"2025082703200118000_2013.may17_1.bcr2012008011.3","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1007\/BF03351067","article-title":"The endocrinology of adrenal tuberculosis: the effects of tuberculosis in hypothalamo-pitutatry-adrenal axis and adrenal cortical function","volume":"2013","author":"Kelestimur","year":"2004","journal-title":"Endocrinol Invest"},{"key":"2025082703200118000_2013.may17_1.bcr2012008011.4","first-page":"2941","volume-title":"Disorders of the adrenal cortex in Harrison's Ppinciples of internal medicine","volume":"2","author":"Wiebke","year":"2012"},{"key":"2025082703200118000_2013.may17_1.bcr2012008011.5","first-page":"1340","volume-title":"Tuberculosis, in Harrison's principles of internal medicine","volume":"1","author":"Mario","year":"2012"},{"key":"2025082703200118000_2013.may17_1.bcr2012008011.6","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1046\/j.1365-2265.2001.01266.x","article-title":"Critical examination of adrenal tuberculosis and a 28-year autopsy experience of active tuberculosis","volume":"2013","author":"Lam","year":"2001","journal-title":"Clin Endocrinol (Oxf)"},{"key":"2025082703200118000_2013.may17_1.bcr2012008011.7","unstructured":"Stewart PM Krone NP . The adrenal cortex. In: Kronenberg HM Melmed S Polonsky KS Larsen PR , eds. Williams textbook of endocrinology. 12th edn. Philadelphia, PA: Saunders Elsevier, 2011:2263, chapter 15."},{"key":"2025082703200118000_2013.may17_1.bcr2012008011.8","first-page":"126","article-title":"Addison's disease due to adrenal tuberculosis: contrast-enhanced CT features and clinical duration correlation","volume":"2013","author":"Guo","year":"2006","journal-title":"Eur J Radiol"},{"key":"2025082703200118000_2013.may17_1.bcr2012008011.9","first-page":"226","article-title":"CT findings of adrenal glands in patients with tuberculous Addison's disease","volume":"2013","author":"Wang","year":"1998","journal-title":"J Belge Radiol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2012-008011","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:20:07Z","timestamp":1756290007000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2012-008011"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,5,17]]},"references-count":9,"alternative-id":["10.1136\/bcr-2012-008011"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2012-008011","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2013,5,17]]}}}