Rarity in Rare: Complicated Disseminated Tuberculosis: A Report of Two Case

Disseminated Tuberculosis (TB) is a severe form of TB that affects multiple organ systems and can lead to complex clinical presentations. Deep Venous Thrombosis (DVT) and Autoimmune Hemolytic Anemia (AIHA) are very rare complications posing diagnostic and therapeutic challenges, requiring a multidisciplinary approach to management. Moreover, In-hospital mortality is higher in patients with such complications compared to those with TB alone. Early recognition and prompt initiation of appropriate therapy are crucial in improving patient outcomes. We report two cases of complicated disseminated TB posing diagnostic and therapeutic challenges. The first case involves a 76-year-old male with a history of chronic smoking, who presented with bilateral leg swelling, fatigue and tooth ache. Diagnostic workup revealed disseminated TB with DVT and AIHA. Despite initial steroid therapy, Blood Transfusion (BT) and Anti-Tuberculosis Treatment (ATT), the patient’s hemoglobin levels continued to fall, necessitating Intravenous Immunoglobulin (IVIG) therapy. The second case involves a 50-year-old female presenting with painful swelling of the left lower limb with past history of significant weight loss and cough. Comprehensive imaging and microbiological studies suggested disseminated TB and DVT. Both patients were managed with ATT and anticoagulation. These cases highlight the complex interplay between TB, DVT and AIHA. Management of such patients requires a multidisciplinary approach, careful balance between ATT, choice of anticoagulation and immunosuppressive treatment.