The April 12, 2022, session of Duke Medicine LEADS featured Ann Cameron Barr, MD, Michael Cosiano, MD, and Sean Taasan, MD presenting "An Unlikely Diagnostic Pathway for Fever of Unknown Origin."
Pearls
-
Though Mycobacterium tuberculosis (TB) infection commonly affects the lungs, up to 21% of cases in the United States present with only extrapulmonary disease. Urogenital TB, including testicular TB, occurs rarely but may present with sterile pyuria and elevated PSA, as well as a scrotal nodule in up to 50%.
-
Tuberculosis meningitis is an uncommon presenting feature of TB that occurs in approximately 1% of TB cases in the United States and is associated with high mortality. Symptoms are similar to bacterial meningitis with fever, stiff neck, headache, and vomiting, however, TB meningitis tends to present more subacutely than bacterial causes. In cases where TB meningitis is suspected, patients should be immediately started on empiric TB-directed therapy as well as steroids based on data showing improvement in mortality.
-
Tuberculosis sepsis is rare and usually occurs in immunosuppressed individuals, typically those with concomitant HIV/AIDS. Sepsis physiology is thought to be secondary to tumor necrosis factor production stimulated by TB. 4-drug regimen remains mainstay of treatment in this setting.
Duke Medicine Learning, Education, and Discussion Series (LEADS) takes place each Tuesday at 12 p.m. Learn more and see schedule of upcoming sessions.