This document discusses extrapulmonary tuberculosis, which can affect any organ outside of the lungs. It affects around 15% of tuberculosis cases. Diagnosis and management may differ from pulmonary tuberculosis. Standard antitubercular treatment is usually HRZE for 2 months followed by HR for 4 months, though treatment duration may vary depending on the specific extrapulmonary site affected such as the lymph nodes, pleura, pericardium, peritoneum, meninges, gastrointestinal tract, skeletal system, genitourinary tract, or disseminated miliary tuberculosis. Surgery may sometimes be needed for complications or management.

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