Fiebre de origen desconocido, una forma de presentarse la tuberculosis

La tuberculosis es una causa importante de fiebre de origen desconocido. Dentro de los factores de riesgo para estar infectado por el bacilo tuberculoso se encuentra la edad, la presencia de comorbilidades, la competencia inmunologica y la alta prevalencia de la enfermedad en el area geografica. Los hallazgos clinicos, radiologicos, epidemiologicos y la respuesta a la terapeutica antimicrobiana, pueden orientar en el diagnostico de esta enfermedad infecciosa. Se presenta un caso en el que los elementos clinicos y epidemiologicos (padre con diagnostico de tuberculosis) llevaron finalmente a la sospecha diagnostica de tuberculosis extra pulmonar, que no pudo ser demostrada por cultivo, pero la respuesta terapeutica resulto concluyente, ya que, una vez iniciada esta, hubo total remision del cuadro clinico y recuperacion nutricional. La terapia antituberculosa con caracter terapeutico y diagnostico debe ser considerada en todo paciente con fiebre de origen desconocido, que, ademas, presente elementos clinicos y epidemiologicos que justifiquen la posibilidad de infeccion por el bacilo. Tuberculosis is an important cause of fever of unknown origin. Among the risk factors of getting infected by the tuberculosis bacillus are age, presence of comorbidities, immunological competence and high prevalence of the disease in a geographical area. The clinical, radiological and epidemiological findings along with the response to antimicrobial treatment can guide the physician to the correct diagnosis of this infectious disease. Here is a case in which the clinical and epidemiological elements (the father of the patient diagnosed with tuberculosis) led to diagnostic suspicion of extrapulmonary tuberculosis. It was not possible to demonstrate it by culturing, but the response to therapy was conclusive, since once the treatment began, there were total remission of the clinical picture and nutritional recovery. The therapeutically and diagnostically oriented anti-tuberculosis treatment should be borne in mind whenever there is a patient with fever of unknown origin and with other clinical and epidemiological evidence that support the possibility of tuberculosis infection.