LATE GENERALIZED TUBERCULOSIS - UNUSUAL FEATURES OF AN OFTEN OVERLOOKED DISEASE

Late generalized tuberculosis - ie, disseminated tuberculosis occurrin g long after the primary infection - is an often unrecognized cause of severe illness in patients with relative immunocompromise, such as th e elderly, alcoholics, or those with chronic illnesses, It has become increasingly recognized in the elderly as a cause of a gradual debilit ating illness, often with vague constitutional symptoms, We describe t hree cases of late generalized tuberculosis in patients seen on a sing le medical service over a 6-month period, Each case presents unique fe atures of extrapulmonary tuberculosis that escaped diagnosis for some time, and each of these elderly patients had a protracted and wasting illness, We present these cases and the ensuing discussion to reemphas ize to clinicians that late generalized tuberculosis may be experienci ng increased prevalence among the elderly and that diagnosis requires a heightened suspicion, A history of past tuberculous infection is not always present, but the diagnosis should be entertained in any elderl y patient with a chronic debilitating illness.