Tuberculous Gumma in Multi Drug Resistant Tuberculosis : A Rare Case Irawaty Djaharuddin, Rina Angrainy*,Jamaluddin Madolangan, Muzakkir Amir, Sri Ramadany
Department of Pulmonology and Respiratory Medicine, Department of Cardiology and Vascular Medicine, Department of Community Medical Science, Hasanuddin University, Makassar, South Sulawesi, Indonesia
Abstract
Introduction: The incidence of extra-pulmonary tuberculosis (TB) has a much stronger relationship with HIV infection. Only 1-2% of all extra-pulmonary TB cases are cutaneous TB. Case: Female, 32-years-old, complained of tuberculosis-related symptoms and progressive swelling in the left lower abdomen for 2 months. The patient had history of cured pulmonary tuberculosis at 2018. She was currently positive MTB through acid bacilli smears and GeneXpert MTB showed multi drug resistant (MDR) pulmonary tuberculosis. Abdominal physical examination was found a cystic mass with negative either pregnancy test or ELISA for HIV test. Chest X-Ray, abdominal ultrasonography, and biopsy of cystic mass were done. It was found that GeneXpert MTB of the biopsy tissue showed MDR tuberculous gumma. Discussion: Tuberculous gumma or metastatic tuberculosis abscess is a form of cutaneous tuberculosis with predilection in extremity, trunk, and head and neck. Another site of tuberculosis can be found with tuberculous gumma. The key diagnosis is giant epithelioid cell granuloma in pathological finding. Conclusion: The incidence of tuberculous gumma in immunocompetent patient was rare. Tuberculosis (TB) can have various manifestation and still very much among us.
Keywords: multi drug resistant, pulmonary tuberculosis, tuberculous gumma, immunocompetent
