Rare manifestations of extrapulmonary tuberculosis in children and adolescents

Abstract

Background: Tuberculosis (TB) is a contagious disease caused by Mycobacterium tuberculosis. Extrapulmonary tuberculosis (EP-TB) is more frequent in children and adolescents, characterized by hematogenous and lymphatic dissemination. The lack of robust epidemiological data on EP-TB in children in Brazil hinders understanding of its organ distribution. Methods: This study retrospectively analyzed a case series of rare EP-TB manifestations treated at a referral service in Minas Gerais, Brazil, between 2021 and 2025. Cases included cutaneous, bone, gastrointestinal, and genitourinary tuberculosis. Data collection involved reviewing medical records of diagnosed patients, with institutional ethical approval (CAAE 6540419.4.0000.5119.). Results: Eleven patients (eight female, three male, aged one to 17 years) were evaluated. Diagnoses included cutaneous tuberculosis (five patients), abdominal tuberculosis (four patients), bone tuberculosis (three patients), and renal tuberculosis (one patient). Two patients had multiple extrapulmonary manifestations, and five had concomitant pulmonary involvement. Microbiological confirmation was achieved in seven patients. Nine patients experienced complete symptom resolution, while one developed reduced renal function and another had residual motor sequelae. Conclusions: Extrapulmonary tuberculosis in pediatric patients presents a significant clinical challenge due to non-specific symptoms and insidious progression, often mimicking other diseases. The paucibacillary nature of the disease necessitates molecular and imaging tests for diagnosis. Early detection and accurate diagnosis are crucial to prevent complications and ensure favorable clinical outcomes.