Disseminated Tuberculosis with Pleural, Hepatic, and Splenic Involvement in an Immunocompetent Adult

Disseminated tuberculosis represents hematogenous spread of Mycobacterium tuberculosis involving multiple organ systems. Although commonly associated with immunosuppression, it can occasionally occur in immunocompetent individuals and pose diagnostic challenges. The authors report an immunocompetent adult who presented with constitutional symptoms and respiratory complaints. Imaging revealed pleural effusion with hepatic and splenic involvement, raising an initial differential diagnosis of disseminated infection or malignancy. Microbiological evaluation demonstrated positivity for M. tuberculosis in cartridge-based nucleic acid amplification testing from both sputum and gastric aspirate, confirming active tuberculosis with multisystem involvement. The patient was HIV-negative and had no underlying comorbidities or immunosuppressive conditions. Antitubercular therapy was initiated with significant clinical and radiological improvement.