{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T20:32:52Z","timestamp":1773001972422,"version":"3.50.1"},"reference-count":14,"publisher":"California Digital Library (CDL)","issue":"3","license":[{"start":{"date-parts":[[2020,6,4]],"date-time":"2020-06-04T00:00:00Z","timestamp":1591228800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction: Disseminated tuberculosis (TB) is rare, affects any organ system, and presents mainly in immunocompromised populations. Typical presentation is non-specific, posing a challenge for diagnosis. \n\nCase Report: This case presents an immunocompetent male presenting with severe headaches with meningeal signs. Lab and lumbar puncture results suggested bacterial meningitis, yet initial cerebral spinal fluid cultures and meningitis\/encephalitis polymerase chain reaction were negative. A chest radiograph (CXR) provided the only evidence suggesting TB, leading to further tests showing dissemination to the brain, spinal cord, meninges, muscle, joint, and bone. \n\nDiscussion: This case stands to acknowledge the difficulty of diagnosis in the emergency department (ED), and the need for emergency physicians to maintain a broad differential including disseminated TB as a possibility from the beginning of assessment. In this case, emergency physicians should be aware of predisposing factors of disseminated TB in patients presenting with non-specific symptoms. They should also acknowledge that TB may present atypically in patients with minimal predisposing factors, rendering the need to further investigate abnormal CXR images despite lab results inconsistent with TB.\n\nConclusion: While this diagnosis is easily missed, early identification in the ED can lead to optimal treatment.<\/jats:p>","DOI":"10.5811\/cpcem.2020.3.46183","type":"journal-article","created":{"date-parts":[[2020,8,12]],"date-time":"2020-08-12T19:31:18Z","timestamp":1597260678000},"page":"375-379","source":"Crossref","is-referenced-by-count":10,"title":["A Case Report of Widely Disseminated Tuberculosis in Immunocompetent Adult Male"],"prefix":"10.5811","volume":"4","author":[{"given":"Samantha","family":"Esposito","sequence":"first","affiliation":[{"name":"Lehigh Valley Health Network\/USF Morsani College of Medicine, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Levi","sequence":"additional","affiliation":[{"name":"Lehigh Valley Health Network\/USF Morsani College of Medicine, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zachary","family":"Matuzsan","sequence":"additional","affiliation":[{"name":"Lehigh Valley Health Network\/USF Morsani College of Medicine, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Amaducci","sequence":"additional","affiliation":[{"name":"Lehigh Valley Health Network\/USF Morsani College of Medicine, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Richardson","sequence":"additional","affiliation":[{"name":"Lehigh Valley Health Network\/USF Morsani College of Medicine, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"29705","published-online":{"date-parts":[[2020,6,4]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Sharma SK, Mohan A, Sharma A, et al. Miliary tuberculosis: new insights into an old disease. Lancet Infect Dis. 2005;5(7):415-30.","DOI":"10.1016\/s1473-3099(05)70163-8"},{"key":"ref1","unstructured":"Centers for Disease Control and Prevention. Trends in tuberculosis, 2018. 2019. Available at: https:\/\/www.cdc.gov\/tb\/publications\/factsheets\/statistics\/tbtrends.htm. Accessed February 5, 2020."},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Righi E, Siega RD, Merelli M, et al. Comparison of clinical characteristics of tuberculosis between two age groups at an Italian tertiary hospital. Infection. 2015;43(3):361-6.","DOI":"10.1007\/s15010-015-0765-y"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Sharma SK, Mohan A, Sharma A. Miliary tuberculosis: a new look at an old foe. J Clin Tuberc Other Mycobact Dis. 2016;3:13-27.","DOI":"10.1016\/j.jctube.2016.03.003"},{"key":"ref4","unstructured":"Sharma SK, Mohan A, Sharma A.  Challenges in the diagnosis & treatment of miliary tuberculosis. Indian J Med Res. 2012;135(5):703-30."},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Garg RK, Sharma R, Kar AM, et al. Neurological complications of miliary tuberculosis. Clin Neurol Neurosurg. 2010;112(3):188-92.","DOI":"10.1016\/j.clineuro.2009.11.013"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Meira L, Chaves C, Ara\u00fajo D, et al. Predictors and outcomes of disseminated tuberculosis in an intermediate burden setting. Pulmonol. 2019;25(6):320-7.","DOI":"10.1016\/j.pulmoe.2018.11.001"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Medoza M and Sheele JM. An unusual presentation of disseminated Mycobacterium tuberculosis in the ED. Am J Emerg Med. 2016;34(9):1915e5-7.","DOI":"10.1016\/j.ajem.2016.02.010"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Megarbane B, Lebrun L, Marchal P, et al. Fatal Mycobacterium tuberculosis brain abscess in an immunocompetent patient. Scand J Infect Dis. 2000;32(6):702-3.","DOI":"10.1080\/003655400459694"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Martins R, Casmiro C, Valverde A, et al. A rare presentation of invasive tuberculosis of the central nervous system in an immunocompetent patient in a nonendemic country. Case Rep Neurol Med. 2018;2940947.","DOI":"10.1155\/2018\/2940947"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Eshiwe C, Shahi F, Gordon N, et al. Rare and unusual case of hepatic and disseminated tuberculosis in an immunocompetent patient. BMJ Case Rep. 2019;12(6):22.","DOI":"10.1136\/bcr-2019-229384"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Madhyastha SP, Gopalaswamy V, Acharya RV, et al. Disseminated tuberculosis in relatively asymptomatic young woman. BMJ Case Rep. 2017.","DOI":"10.1136\/bcr-2017-219276"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society\/Centers for Disease Control and Prevention\/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. CID. 2016;63(7):e147-95.","DOI":"10.1093\/cid\/ciw376"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Thwaites GE, Bang ND, Dung NH, et al. Dexamethasone for the treatment of tuberculosis meningitis in adolescents and adults. N Engl J Med. 2004;351(17):1741-51.","DOI":"10.1056\/NEJMoa040573"}],"container-title":["Clinical Practice and Cases in Emergency Medicine"],"original-title":[],"deposited":{"date-parts":[[2020,9,16]],"date-time":"2020-09-16T19:10:53Z","timestamp":1600283453000},"score":1,"resource":{"primary":{"URL":"https:\/\/escholarship.org\/uc\/item\/2vt7t6hn"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,4]]},"references-count":14,"issue-title":["Clinical Practice and Cases in Emergency Medicine"],"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,8,6]]}},"URL":"https:\/\/doi.org\/10.5811\/cpcem.2020.3.46183","relation":{},"ISSN":["2474-252X","2474-252X"],"issn-type":[{"value":"2474-252X","type":"electronic"},{"value":"2474-252X","type":"print"}],"subject":[],"published":{"date-parts":[[2020,6,4]]}}}