Multiple Cold Abscesses Without Respiratory Symptoms Revealing Multifocal Tuberculosis: A Case Report

Soft-tissue tuberculosis is an uncommon extrapulmonary manifestation and may be difficult to recognize when respiratory symptoms are absent.We report a 33-year-old, HIV-negative Sri Lankan woman without diabetes or known pharmacological immunosuppression who presented with three months of progressively enlarging, minimally tender superficial collections over the left wrist, right knee, and right ankle, accompanied by anorexia and unquantified weight loss.The swellings had minimal local inflammatory signs.She was anemic and hypoalbuminemic, with elevated inflammatory markers.Separate drainage specimens from all three sites were negative on acid-fast bacillus smear but positive for Mycobacterium (M.) tuberculosis complex by Xpert MTB/RIF, without rifampicin resistance; cultures from all three sites subsequently grew M. tuberculosis complex.Chest imaging showed bilateral loculated pleural effusions, nodular pleural thickening, and bilateral tree-in-bud nodules.These abnormalities were compatible with probable pleuropulmonary tuberculosis but were not diagnostic.Sputum investigations were negative, and pleural fluid could not be obtained.The case was classified as microbiologically confirmed multifocal softtissue tuberculosis with probable pleuropulmonary involvement.All three collections were drained, and first-line antituberculous therapy was initiated.At two months, the lesions remained resolved without recurrence or new lesions; appetite and well-being had improved; weight had increased by 4 kg; erythrocyte sedimentation rate had decreased from 125 to 36 mm/hour; and chest radiography showed near-complete resolution of the pleural effusions.Adherence was satisfactory, and no adverse effects were reported.These findings represented an early clinical and radiological response rather than definitive treatment success.