Endobronchial tuberculosis revealing extensive multiorgan dissemination in a severely malnourished immunocompetent adult.

A woman in her mid-30s presented with a 3-month history of dry cough, profound weight loss and anorexia. Evaluation revealed pulmonary tuberculosis microbiologically confirmed by bronchoalveolar lavage cartridge-based nucleic acid amplification testing (CBNAAT) together with histopathological evidence from endobronchial biopsy, with extensive dissemination involving the pleura, pericardium, peritoneum, omentum, liver and colon. Bronchoscopy demonstrated multiple nodular endobronchial lesions while bronchoalveolar lavage CBNAAT detected Mycobacterium tuberculosis without rifampicin resistance. Endobronchial biopsy showed granulomatous inflammation consistent with tuberculosis. The patient was HIV-negative and non-diabetic but had severe protein-energy malnutrition, with a body mass index of 12.9 kg/m². Cutaneous lesions over the extremities initially raised suspicion of vasculitis; however, autoimmune evaluation including antinuclear antibody testing and serum angiotensin-converting enzyme levels was unremarkable. The clinical course was further complicated by antitubercular therapy-induced hepatitis and severe left ventricular systolic dysfunction, necessitating modification of therapy. This case highlights the protean manifestations of disseminated tuberculosis, the diagnostic value of bronchoscopy and molecular testing in sputum smear-negative disease and the challenges of management in severely malnourished individuals.