title: Synchronous presentation of two rare forms of extrapulmonary tuberculosis.
abstract: Tuberculosis (TB) remains one of the leading infectious causes of death throughout the world. Extrapulmonary forms, namely adrenalitis and prostatitis, are rare presentations of TB and pose a difficult diagnostic challenge, given their non-specific manifestations. The authors present a case of a 42-year-old man with long-standing symptoms of fatigue, anorexia, weight loss, nightly fever and sudoresis. He also suffered from sporadic vomiting and episodic hypotension, and had skin hyperpigmentation, as well as frequent urination, perineal discomfort and pain at ejaculation. Laboratory investigation confirmed primary adrenal failure. On CT scan there were two hypodense right adrenal nodules and bilateral lung condensations with a tree-in-bud pattern. Another hypodense nodule was seen in the prostate. TB was diagnosed by isolatingMycobacterium tuberculosisfollowing cultures of bronchoalveolar lavage, bronchial secretions, urine and ejaculate. Antibacillary treatment resolved the infectious lesions but the patient remained on corticosteroid replacement therapy for ongoing adrenal failure.
authors.affiliation: Department of Medicine 2, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.
authors.forename: Marta Catarino
authors.initials: MC
authors.lastname: Manso
authors.affiliation: Department of Medicine 2, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.
authors.forename: Simão C
authors.initials: SC
authors.lastname: Rodeia
authors.affiliation: Department of Medicine, Hospital de Cascais, Cascais, Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Rodrigues
authors.affiliation: Department of Medicine 2, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.
authors.forename: Raquel
authors.initials: R
authors.lastname: Domingos
mesh_terms: D000309:Adrenal Insufficiency / Q000000981:diagnostic imaging / Q000382:microbiology; D000328:Adult; D000855:Anorexia / Q000382:microbiology*; D005221:Fatigue / Q000382:microbiology*; D005334:Fever / Q000382:microbiology; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011469:Prostatic Diseases / Q000000981:diagnostic imaging / Q000382:microbiology*; D013546:Sweating; D014057:Tomography, X-Ray Computed; D014383:Tuberculosis, Endocrine / Q000150:complications* / Q000382:microbiology; D014389:Tuberculosis, Male Genital / Q000150:complications* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging; D015431:Weight Loss