Case report: extra pulmonary tuberculosis in sickle cell disease.

In apparently healthy individuals, tuberculosis (TB) affects mainly the lungs however, worsening immune status tend to predispose to an increased tendency for extra-pulmonary tuberculosis (EPTB). We report the case of a 22 year old known sickle cell anaemia (HBS) female student with three-month history of bilateral hip pain, weight loss and swelling of the left hip with multiple discharging sinuses, paraplegia and recurrent fever. There was no preceding history of trauma. Full Blood Count (FBC) revealed leukocytosis with neutrophilia, monocytosis, thrombocytosis and Packed Cell Volume (PCV) of 23%. Erythrocyte sedimentation rate (ESR) was 120mm/Hr (Western Green) and retroviral screening was negative. Bacteriologic culture of the discharging sinuses grew Escherichia coli and Staphylococcus aureus, both sensitive to sparfloxacin. Smear microscopy for acid-fast-bacilli (AFB) was negative. Chest X-Ray was reported normal but X-Ray of the pelvis showed loss of L4/L5 disc space and appearances suggestive of avascular necrosis of the femoral heads. Clinical and haematological profile of the patient started to improve by the second month on therapeutic trial of anti-TB regimen. She had nine-month course of therapy and later discharged to physiotherapy clinic. Management of EPTB requires a high index of clinical suspicion and well-equipped laboratory to support the diagnosis. Therefore, this case report highlights the need to upgrade TB-diagnostic facilities in this environment.