Mistaken identity: Reporting two cases of rare forms of extrapulmonary tuberculosis in Solomon Islands

Introduction and importance: Extrapulmonary tuberculosis (EPTB) is a relatively rare and difficult-to-diagnose manifestation of Myobacterium tuberculosis (TB) infection. Case presentation: This study reports the cases of a 47-year-old male and a 35-year old female with rare forms of EPTB who sought medical care in Solomon Islands. Both patients presented with nondescript symptoms and a chief complaint of pain. Initial diagnosis for the male and female patient was an abacterial colon polypoid mass and a urinary tract infection (UTI) respectively. Following unsuccessful treatment for UTI and further investigation, the surgical team diagnosed the female patient with a tuberculosis spondylitis and a bilateral psoas abscess. The male patient was subsequently diagnosed with isolated colonic tuberculosis. After starting medication, the patients were discharged and prescribed 9-month treatment regimens. During outpatient treatment both patients reported suboptimal adherence. The female patient resumed treatment and showed improvement while the male patient discontinued treatment, experienced worsening symptoms, and ultimately died. Clinical discussion: The nonspecific symptoms of extrapulmonary TB infection make it difficult to diagnose. Cases of rare forms of EPTB are particularly challenging to identify. Misdiagnosis may further increase the likelihood of mortality and morbidity in these cases. Intensive medication counseling, patient outreach, and regularly scheduled follow-up visits may reduce the incidence of poor adherence and reduce the risk of developing drugresistant TB. Conclusion: Medical practitioners in tuberculosis-endemic countries like Solomon Islands should maintain a high clinical index of suspicion in diagnosing EPTB. Future research should investigate the prevalence of TB and EPTB in the Solomon Islands.