Abstract

Introduction: MDR TB usually occurs in anti tubetubercular treatment defaulters or those with history of contact to MDR TB. But rarely it may occur as a primary case in persons without history of ATT or contact to TB patients.

Case Report: A female presented in our hospital with complains of pain in right leg and fever on and off since last 2 months.

O/E: The patient had a swelling in right leg of size 30×15×25 mm which was tender, non-pulsatile and oval in shape. She had no history of tuberculosis or contact to tuberculosis in past. Chest xray, sputum examination and CECT Thorax were normal. Monteux test was positive (50mm). So, patient was started on category 1 ATT empirically.

USG Abdomen and CECT Abdomen confirmed right psoas abcess, for which pus was drained multiple times and was sent for LPA examination in which resistance to isoniazid and rifampicin was detetcted. Then she was started on 2nd line ATT including kanamycin, pyrazinamide, ethionamide, ethambutol, cycloserine, and levofloaxacin as per weight bands. On starting ATT, her general condition improved and she was discharged on 2nd line ATT.

Discussion: Psoas (or illio-psoas) abcess is collection of pus in the illio-psoas muscle compartment. It may arise via contiguous spread from adjacent structures or by the haematogenous route from distant site. USG or CECT Abdomen allow good accuracy for early diagnosis.

Conclusion: Extra-pulmonary MDR TB without history of ATT or contact to MDR-TB is rare. High clinical suspicion and gene xpert test may be the key for early and accurate diagnosis of the patient.