Extrapulmonary tuberculosis revisited: a review of experience at Boston City and other hospitals.

During a 10-year period, 136 patients with extrapulmonary tuberculosis were seen at Boston City Hospital and other hospitals affiliated with Boston University School of Medicine. Review of these cases revealed that the prevalence of extrapulmonary tuberculosis was declining less rapidly than that of pulmonary disease. Extrapulmonary disease represented 4.5% of all new cases of active tuberculosis and tended to occur in older patients than in previous reports. Sites of involvement included lymph nodes, blood, genitourinary tract, bone and articular sites, the meninges, peritoneum, adrenal glands, pericardium, and miscellaneous sites, in this order. Diagnosis was confirmed by a variety of techniques whose relative merits are discussed. Overall, 14 deaths occurred among the 136 patients. One-half of the deaths resulted from causes other than tuberculosis and two patients died before diagnosis and initiation of therapy. Evaluation of the relative efficacy of therapeutic regimens was hampered by a high degree of recidivism in this population and the multitude of regimens utilized. These observations indicate that extrapulmonary tuberculosis still occurs with substantial frequency among patients seen in "inner-city" hospitals and that its recognition may be complicated by its occurrence in older patients with other medical conditions.