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What do you need to know about Extrapulmonary Tuberculosis?

Tuberculosis outside the lungs is known as extrapulmonary tuberculosis (TB). Although the primary site of infection is the lungs, the infection can extend to other organs.

Symptoms vary with the site of infection but generally include fever, malaise, and weight loss.

Some of the types of extrapulmonary TB include:

Miliary tuberculosis:

Miliary TB occurs when a TB lesion erodes into a blood vessel, disseminating millions of the infection-causing bacteria into the bloodstream and throughout the body.

The lungs and bone marrow are most often affected, but any site may be involved. Miliary TB is most common among

  • Children < 4 years old

  • Older people

  • Immunocompromised people

Symptoms include fever, chills, malaise, weakness, and progressive dyspnea. Prolonged fever of unknown origin (FUO) is common. Bone marrow involvement may cause anaemia, thrombocytopenia, or a leukemoid reaction.

Genitourinary tuberculosis

When the TB infection spreads to the urinary system, it is known as genitourinary TB. Infection of the kidneys may cause pyelonephritis (e.g., fever, back pain, pyuria).

TB infection commonly spreads to the bladder and, in men, to the prostate, seminal vesicles, or epididymis, causing an enlarging scrotal mass. Infection may spread to the surrounding muscles causing an abscess on the anterior thigh.

Meningeal tuberculosis

When TB infection affects the brain, it is known as TB meningitis or meningeal tuberculosis.

Meningitis is the most severe form of TB at any age and has high morbidity and mortality.

Symptoms include a low-grade fever, unremitting headache, nausea, and drowsiness, which may progress to stupor and coma.

A stroke may result from thrombosis of a major cerebral vessel. Focal neurologic symptoms suggest a tuberculoma.

Peritoneal tuberculosis

Peritoneal infection usually happens when the TB infection spreads from the abdominal lymph nodes. Peritonitis is particularly common among people with alcohol use disorder or cirrhosis.

Symptoms usually are mild, with fatigue, abdominal pain, and tenderness, or severe enough to mimic acute abdomen.

Pericardial tuberculosis

TB of the heart is known as Pericardial tuberculosis. TB pericarditis is a common cause of heart failure in some high-incidence parts of the world. Patients may have pleuritic and positional chest pain or fever. Pericardial tamponade may occur, causing dyspnea, neck vein distention, paradoxical pulse, muffled heart sounds, and possibly hypotension.

Cutaneous tuberculosis

Cutaneous tuberculosis results from the direct extension of an underlying TB focus to the overlying skin, forming ulcers and sinus tracts. Rarely TB infection develop on abraded skin in patients with cavitary pulmonary TB.

Tuberculosis of bones and joints

Weight-bearing joints are most commonly affected by the TB, but bones of the wrist, hand, and elbow may also be affected, especially after an injury.

Other sites of TB infection

TB may infect a blood vessel's wall and even rupture the aorta. Adrenal involvement leads to Addison's disease. Tubercle bacilli may spread to tendon sheaths by direct extension from adjacent lesions in bone.


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