BACKGROUND AND OBJECTIVE: Mycobacterium TUBERCULOSIS affects millions of people in the world and Iran is one of the endemic areas. This disease has a wide range of manifestations, which is pulmonary in 80 – 85% of cases and extrapulmonary in 15 – 20% of cases. The most notable extrapulmonary infection sites are lymph nodes, pleura, genitourinary system and digestive system. Considering the prevalence of TUBERCULOSIS in Iran, familiarity with the uncommon manifestations of this infection seems to be essential for timely diagnosis and treatment. Therefore, a rare extrapulmonary manifestation of TUBERCULOSIS is reported here. CASE REPORT: The patient was a 64 – year – old woman who was hospitalized due to fever, icterus, decreased consciousness and progressive asymmetrical weakness of the limbs. Symptoms of focal neurologic deficits and heart murmurs were found in examinations. During the tests, including brain and spinal imaging, cerebrospinal fluid analysis, computed tomography of the abdomen and pelvis, and echocardiography, extrapulmonary TUBERCULOSIS (cerebral abscess, spondylitis, liver and spleen abscess, psoas muscle abscess, and possible endocarditis) was confirmed. Four-drug regimen including isoniazid, rifampin, ethambutol, and pyrazinamide with vitamin B6 was started for two months, and two-drug regimen continued for 10 months. At the end of the course of treatment, the patient was able to walk with the cane in good general condition. CONCLUSION: Considering the reported case, paying attention to some of the more uncommon manifestations of the disease can prevent mortality and disability.

Distribution of EPTB in developing and developed countries is different. We evaluated 146 cases (96 Female and 50 male) of EPTB in Chaharmal va-Bakhtiari province in central part of Iran during a period of 8 years.In this survey EPTB was 27% of all TUBERCULOSIS patients and relative increased incidence of EPTB seen in recent years. Young female (20-39) years and older male (60-69) years were more predispose to EPTB. Overall female had twice chance of developing disease than male.Tuberculos lymphadenitis was the most common EPTB (42%) and after that skeletal TUBERCULOSIS (18%) and gastrointestinal TUBERCULOSIS (10%) was seen. T.B pleuritis was not common as in developed countries.Biopsy of suspected organ was the most useful method for definitive diagnosis. Majority (70%) of all cases had positive Tuberculin skin test.We conclude that increase cases of EPTB are due to improvement of diagnosis methods or missing of diagnosing of new cases of pulmonary TUBERCULOSIS.Increased rate of incidence of skeletal TUBERCULOSIS in Iran should be evaluated in future studies.

Background: TUBERCULOSIS (TB) is one of the main health issues in Turkey. Extrapulmonary TB cases have significant proportion comparing pulmonary TB cases. The aim of the study was to evaluate the extrapulmonary TUBERCULOSIS (EPTB) cases in two regions of Turkey, which have different demographic and socioeconomic characteristics.Methods: In this retrospective cohort study, EPTB cases between 2000 and 2005 in Van and Izmir Provinces of Turkey were analyzed and compared for symptoms, age groups, vaccination status, diagnostic procedures and social-economical conditions within two provinces. Descriptive analytic methods were used.Results: Total of 397 EPTB cases were reviewed retrospectively in Izmir and Van provinces. Pleural TB was most often seen EPTB form (47.6% vs.32.6%) and female/male ratio was similar in both groups. Patients were in older ages in Izmir Province. Chest pain (20% vs.32%), cough (33% vs.26%) and night sweatiness (29% vs.36%) were leading complaints. Low BCG vaccination rate and higher childhood EPTB were found in Van group, in contrary elderly EPTB was more often in of Izmir group.Conclusion: Frequency of severe forms of EPTB is more often in younger ages in lower social economical condition areas.