TUBERKULOSIS MILIER DISERTAI SKROFULODERMA DAN SPONDILITIS TUBERKULOSIS

Abstract

Miliary tuberculosis is one of the severe forms of TB and constitutes 3-7% of all TB cases, with a high mortality rate (up to 25% in infants). Scrofuloderma (skin TB) is a very rare form of extrapulmonary tuberculosis that varies morphologically. Tuberculous spondylitis, also known as Pott's disease, is an infectious disease caused by Mycobacterium tuberculosis affecting the spine. This case involves a 13-year-old boy who presented with shortness of breath that started 1 week prior and worsened 1 day before admission. He had a productive cough for 2 weeks. There was no fever. He had a purulent, bluish lump in the neck for 1 year, which burst 5 months ago. A lump in the chest was noticed 3 months ago. He experienced difficulty moving both legs for 1 week. There was a history of contact with an adult with pulmonary TB (sputum smear positive). Physical examination revealed lymphadenopathy in the right and left cervical regions. Radiological findings suggested miliary TB, spondylitis, and a positive tuberculin test. The patient was treated with a 4-drug regimen during the intensive phase for 2 months, including rifampicin, isoniazid, pyrazinamide, ethambutol, and prednisone, followed by a continuation phase with 2-drug regimen (rifampicin and isoniazid) for 10 months. In conclusion, this case involves miliary TB, scrofuloderma, and tuberculous spondylitis. The diagnosis was based on the history of a lump in the neck, contact with an infectious adult TB patient (sputum smear positive), characteristic radiological findings, and a positive tuberculin test with a total TB score of 12. The prognosis is doubtful