# Mycobacterium tuberculosis sepsis with multiple intermuscular abscesses and respiratory failure as the main manifestations: a case report

## TL;DR

A 60-year-old woman developed severe tuberculosis sepsis with abscesses and respiratory failure, highlighting the need for early diagnosis using advanced techniques like mNGS.

## Contribution

This case highlights the rare and atypical presentation of tuberculosis sepsis and the utility of mNGS for rapid pathogen identification.

## Key findings

- Tuberculous sepsis can present with intermuscular abscesses and respiratory failure in non-HIV patients.
- mNGS detected Mycobacterium tuberculosis in both blood and abscess fluid, enabling a definitive diagnosis.
- Early anti-tuberculosis treatment led to recovery, emphasizing the importance of timely intervention.

## Abstract

Tuberculous sepsis is uncommon in individuals without human immunodeficiency virus (HIV) infection, and some patients may not exhibit clinical signs and symptoms of suspected sepsis upon admission, leading to delayed diagnosis and treatment.

This report present the case of a 60-year-old female patient who presented with erythema, edema, and pain in her right upper limb accompanied by fever and chills. Further evaluation revealed multiple intermuscular abscesses caused by suspected gram-positive bacteria. Despite receiving anti-infection treatment, the patient rapidly progressed to septic shock and respiratory failure. Metagenomic next-generation sequencing (mNGS) analysis of blood samples detected Mycobacterium tuberculosis complex groups (11 reads). Additionally, mNGS analysis of fluid obtained from puncture of the abscess in the right upper extremity also suggested Mycobacterium tuberculosis complex groups (221 981 reads). Consequently, the patient was diagnosed with tuberculous sepsis resulting from hematogenous dissemination of Mycobacterium tuberculosis. Following the administration of anti-tuberculosis treatment, a gradual recovery was observed during the subsequent follow-up period.

It is noteworthy that atypical hematogenous disseminated tuberculosis can be prone to misdiagnosis or oversight, potentially leading to septic shock. This case illustrates the importance of early diagnosis and treatment of tuberculosis sepsis. Advanced diagnostic techniques such as mNGS can aid clinicians in the early identification of pathogens for definitive diagnosis.