Abstract
Before the COVID pandemic, tuberculosis (TB) was the leading cause of death among infectious diseases. As TB can affect different organs, diagnosis sometimes remains difficult. Here, we present a series of three cases where TB was detected in three different systems after a comprehensive workup. The first case was diagnosed as abdominal TB. She had prolonged fever, weight loss, pain abdomen, shortness of breath with mild ascites, jejunal thickening, and bilateral pleural effusion. The initial workup failed to establish a diagnosis. She was put for diagnostic laparoscopy which aided in diagnosis. The second case was confirmed as nasopharyngeal TB. The patient had recurrent upper respiratory symptoms but relevant investigations including imaging studies and nasal endoscopy were normal. Lung parenchyma was not involved. Nucleic acid amplification test confirmed the diagnosis. The third case was diagnosed as pulmonary TB which was detected only after repeated sputum test. The patient had a history of recurrent hemoptysis with weight loss with a cavitary lesion in the left lung. His consecutive three sputum samples were negative even by nucleic acid amplification test before being positive in the 4th time. Extensive workup and repeated test are required in suspected cases of TB to minimize false negative results.

Key words: Abdominal; Nasopharyngeal; Difficult; Laparoscopy; Cartridge Based Nucleic Acid Amplification Test