Colo‐appendico‐duodenal fistula: Rare presentation of extrapulmonary tuberculosis

Isolated multidrug-resistant (MDR) tubercular tenosynovitis of the flexor tendons of finger without involvement of wrist is a rare presentation. Tenosynovitis of hand is an uncommon manifestation of extrapulmonary tuberculosis. Pyogenic flexor tenosynovitis of hand is frequently seen and is the closest differential. Non-specific clinical signs may lead to delay in diagnosis, which is often made after biopsy. Management includes surgical excision of necrotic tissue and infected synovium along with antitubercular therapy after histopathological diagnosis. MDR tuberculosis of hand is extremely rare and, to the best of our knowledge, has not been reported in the literature so far. We report an interesting case of MDR tubercular flexor tendon tenosynovitis of the little finger without any pulmonary involvement in an immunocompetent patient. The case was managed by complete synovectomy and second-line antitubercular therapy with complete resolution of disease and had no functional limitation.

Download Full-text

Multicentric Spinal Tuberculosis with Sternoclavicular Joint Involvement: A Rare Presentation

Case Reports in Pulmonology ◽

10.1155/2014/685406 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Balaji Saibaba ◽

Umesh Kumar Meena ◽

Prateek Behera ◽

Ramesh Chand Meena

Keyword(s):

Extrapulmonary Tuberculosis ◽

Spinal Tuberculosis ◽

Sternoclavicular Joint ◽

Joint Involvement ◽

Socioeconomic Conditions ◽

Skeletal System ◽

Rare Presentation ◽

Competent Patient ◽

Immunological Status ◽

Radiological Studies

Background. Tuberculosis is a chronic disease which may have varied presentations. Though pulmonary tuberculosis is the commonest, extrapulmonary tuberculosis involving skeletal system is often seen. Individuals with poor nourishment and immunological status are especially susceptible for disseminated and multicentric tuberculosis.Case Report. We here present a case of tuberculosis involving multiple anatomical locations in an immune-competent patient which was diagnosed with radiological studies and confirmed with histological examination. Patient was put on multidrug antitubercular therapy and responded well to the treatment with improvement in clinical and radiological picture.Clinical Relevance. This report of a rare case makes us aware of the varied presentations which tuberculosis can present with. It should be kept as a differential diagnosis in patients with cough and fever but not responding to conventional treatment. This is even more important in countries with poor socioeconomic conditions.

Download Full-text

MON-482 Thyroid Tuberculosis - An Unlikely Diagnosis

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.719 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Alexandra Novais Araújo ◽

Tânia Matos ◽

Ema Nobre ◽

Maria Joao Bugalho

Keyword(s):

Lymph Node ◽

Fine Needle Aspiration ◽

Histopathological Examination ◽

Extrapulmonary Tuberculosis ◽

Needle Aspiration ◽

Tuberculous Infection ◽

Rare Presentation ◽

Adequate Treatment ◽

Fine Needle ◽

The Right

Abstract Background: Mycobacterium tuberculosis (MTB) is an aerobic bacillus responsible for the most cases of tuberculous infection. Approximately one-third of the world’s population is infected. Tuberculosis (TB) of the thyroid gland is an unusual diagnosis with an estimated prevalence of 0.1 to 0.6%. The thyroid TB can mimic different pathologies (thyroid neoplasms, lymphoma, infectious or granulomatous thyroiditis, Graves’ disease or bacterial abscess) and the diagnosis can be easily disregarded, especially in non-endemic countries and if the patient doesn’t have systemic symptoms. The fine needle aspiration and histopathological examination, with acid-fast bacilli staining and TB culture, are the gold standard exams. Clinical Case: A 71-year-old female was referred to our Endocrinology department after a diagnosis of nodular thyroid disease. She had complaints of slight cervical discomfort, with 6 months of duration. She hadn’t personal or familiar relevant antecedents. At observation, a movable, elastic and non-tender nodule of 15mm at the right superior thyroid lobe was identified. Blood tests including a thyroid profile were normal. The neck ultrasound showed, at the right lobe of the thyroid, multiple solid nodules; the dominant had 18mm, was heterogeneous and had multiple calcifications. Moreover, lymph nodes with suspicious ultrasonographic features along the right internal jugular chain were reported. The patient underwent fine-needle aspiration (FNA) of the suspicious thyroid nodule and one lymph node. Results were respectively: non-diagnostic (Bethesda I) and reactive pattern. FNA was repeated on a different occasion and results were similar. Due to ultrasound suspicious of malignancy, a total thyroidectomy was performed and a lymph node from level IV was sampled for extemporaneous examination. Necrotizing granulomas were documented; the Ziehl-Neelson staining (ZNS) was negative; material was sent to microbiology. Following this finding, ganglion emptying was not performed. The thyroid histology showed tuberculoid type granulomas with lymphoid border and central necrosis. However, the ZNS was negative. The diagnosis was definitely established by a positive culture of the lymph node tissue and molecular detection, by polymerase chain reaction (PCR), of MTB. Pulmonary involvement was excluded and she started antituberculous agents planned for 9 months (rifampicin and isoniazid during 9 months and ethambutol and pyrazinamide for 2 months). Conclusion: Thyroid TB is a rare presentation of extrapulmonary tuberculosis. In presence of systemic or specific complaints or history of exposition the diagnosis may be suspected and confirmatory tests requested in order to ensure an adequate treatment. However, sometimes, histopathology remains a key step and the use of cultures improves the sensitivity and specificity of TB tests.

Download Full-text

Pleural nodules: A rare presentation of extrapulmonary tuberculosis

Lung India ◽

10.4103/0970-2113.192855 ◽

2016 ◽

Vol 33 (6) ◽

pp. 699

Author(s):

Urvinderpal Singh ◽

Vinay Mohan ◽

Navdeep Singh ◽

Daksh Jhim ◽

Muralidharan Ramaraj ◽

...

Keyword(s):

Extrapulmonary Tuberculosis ◽

Rare Presentation

Download Full-text

BREAST TUBERCULOSIS-A RARE PRESENTATION OF COMMON DISEASE WITH DIAGNOSTIC AND THERAPEUTIC CHALLENGE.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i4.1075 ◽

2020 ◽

Vol 4 (4) ◽

Author(s):

Swagata Brahmachari ◽

Shashwati Nema ◽

Padma . ◽

VK Ramnani ◽

Vaishali Bhagat ◽

...

Keyword(s):

Low Socioeconomic Status ◽

Predictive Value ◽

Extrapulmonary Tuberculosis ◽

Reproductive Age ◽

Smear Microscopy ◽

Common Disease ◽

Rare Presentation ◽

Idiopathic Granulomatous Mastitis ◽

Breast Tuberculosis ◽

Caseating Granuloma

Background: Breast tuberculosis is a rare extra pulmonary tuberculosis presentation usually misdiagnosed as carcinoma, pyogenic abscess or idiopathic granulomatous mastitis. Detection of tubercular bacilli by ZN stain, culture and CBNAAT along with caseating granuloma on histopathology helps in diagnosis. Aims and Objectives: To study the clinico-pathological characteristic of breast tuberculosis and diagnostic accuracy of CBNAAT for early and specific diagnosis in reference to histopathological test Material and Methods: 38 cases of BTB between August2012 to July 2017 were studied. Culture for acid-fast bacilli, smear positivity on Z-N staining, CBNAAT, and cytological and histological examination was done for confirmation. Results: Prevalence of BTB in this study was found to be 3.95% .The risk factors were reproductive age (20-35), multiparity, lactation and low socioeconomic status. Unilateral lump in the upper outer and central quadrant of the breast was the commonest observation. Only 34.2% were diagnosed provisionally as BTB rest 73.68% were misdiagnosed as fibroadenoma, breast abscess and malignancy Clinically nodulo-caseous variety(55.6 %) disseminated (18.4%) and tubercular abscess (26.3%) were seen. Sensitivity of ZN staining, culture, FNAC and histopathology is 15.8%,5.8%, 74% ,100%respectively. Sensitivity, specificity, positive predictive value, and negative predictive value for the CBNAAT test were 81.818%, 93.103%, 93.10%, and 81.82% respectively.39.4% were cured completely with ATT with 60.52% with residual lesions needed surgery Conclusion: This study highlights the importance of early diagnosis and aggressive medical and if required surgical management to cure this disease. CBNAAT should be used as an additional test to conventional smear microscopy, culture, FNAC and histology. Keywords: Breast tuberculosis, CBNAAT, Extrapulmonary tuberculosis, breast lump

Download Full-text

Tuberculoma of the Tongue Presenting as Hemimacroglossia

Case Reports in Medicine ◽

10.1155/2012/548350 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

S. P. S. Yadav ◽

Arpit Agrawal ◽

J. S. Gulia ◽

Sunita Singh ◽

Arsh Gupta ◽

...

Keyword(s):

Mycobacterium Tuberculosis ◽

Oral Cavity ◽

Clinical Diagnosis ◽

Histopathological Examination ◽

Extrapulmonary Tuberculosis ◽

Slow Process ◽

Common Site ◽

Rare Presentation ◽

Antitubercular Drugs ◽

Carcinoma Of Tongue

The underdiagnosis of extrapulmonary tuberculosis lesions, along with an emerging global resistance to antitubercular drugs, warrants an increased awareness of the involvement ofMycobacterium tuberculosisin atypical lesions of oral cavity. Tongue is the most common site of oral tuberculosis. We report a rare presentation of lingual tuberculosis in a 65-year-old male, a chronic tobacco chewer, who came to us with swelling of the tongue which apparently looked like hemimacroglossia, leading to the clinical diagnosis of submucosal carcinoma of tongue. Enlargement of tongue is a slow process resulting from gradual invasion and lodging of bacilli in the tongue. Biopsy and histopathological examination revealed tuberculous etiology of the lesion and the patient responded well to antitubercular therapy.

Download Full-text

A Rare Manifestation of Tuberculosis Presenting in the United States

Case Reports in Infectious Diseases ◽

10.1155/2016/8216040 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Osman Bhatty ◽

David Waters ◽

Nicholas Wilka ◽

Shradha Samuel ◽

John Horne ◽

...

Keyword(s):

Extrapulmonary Tuberculosis ◽

The United States ◽

Care Physician ◽

Western World ◽

Gram Stain ◽

Breast Lump ◽

Rare Presentation ◽

High Clinical Suspicion ◽

Rare Manifestation ◽

Initial Biopsy

A 64-year-old Bangladeshi female presented to her primary care physician with a tender right breast lump that had been present for 4-5 days along with subjective fevers and malaise. Initial biopsy revealed granulomas, but Ziehl-Neelsen and Gram stain were negative for TB so antibiotics were prescribed for abscess until culture came positive for tuberculosis. She was started on triple therapy for extrapulmonary tuberculosis, an exceedingly rare presentation that requires high clinical suspicion in the Western world.

Download Full-text

Tuberculous Gastric Abscess in a Patient with AIDS: A Rare Presentation

Case Reports in Infectious Diseases ◽

10.1155/2016/5675036 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Ekta Nayyar ◽

Julian A. Torres ◽

Carlos D. Malvestutto

Keyword(s):

Opportunistic Infections ◽

Epigastric Pain ◽

Extrapulmonary Tuberculosis ◽

Immunocompromised Host ◽

Rare Presentation ◽

Accurate Identification ◽

Gastric Tuberculosis ◽

High Clinical Suspicion ◽

Clinical Syndromes ◽

Diagnostic Modalities

Tuberculosis is a healthcare concern that affects millions of individuals around the globe. Coinfection with HIV has changed both the clinical presentation and the outcome of the disease dramatically in the last few decades. Extrapulmonary tuberculosis is seen more frequently in the immunocompromised host. An unusual case of gastric tuberculosis in an AIDS patient is reported here. A 49-year-old female with AIDS was admitted for fever and epigastric pain. A gastric submucosal abscess was observed on imaging and confirmed by biopsy showing numerous neutrophils and acid-fast bacilli. Aspirate grewMycobacterium tuberculosis.This report highlights a very unusual presentation of tuberculosis in an immunodeficient patient. High clinical suspicion for opportunistic infections in unusual locations should be maintained in these patients presenting with clinical syndromes that do not respond to standard treatments. New diagnostic modalities facilitate accurate identification of these infections.

Download Full-text

Obstructive Pseudotumor of Tuberculosis in a Young Woman: A Rare Presentation

Case Reports in Gastrointestinal Medicine ◽

10.1155/2014/914253 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Seyyed Reza Fatemi ◽

M. Ghobakhlou ◽

L. Alizadeh

Keyword(s):

Computed Tomography ◽

Histopathological Examination ◽

Extrapulmonary Tuberculosis ◽

Exploratory Laparotomy ◽

Upper Endoscopy ◽

Retroperitoneal Mass ◽

Rare Presentation ◽

Difficult Diagnosis ◽

Antituberculosis Therapy ◽

High Index Of Suspicion

Retroperitoneal pseudotumor is an extremely rare presentation of extrapulmonary tuberculosis. The diagnosis of this paucibacillary disease is difficult which is usually misdiagnosed as a malignant tumor. High index of suspicion is required for early diagnosis and treatment of retroperitoneal pseudotumor which can affect prognosis of this disease. Because of its rarity and difficult diagnosis, we report an 18-year-old immunocompetent girl who presented with abdominal pain and vomiting. Upper endoscopy showed an exudative mass between the second and third parts of duodenum. Abdominal computed tomography (CT) revealed a large retroperitoneal mass with extension into small bowel. Exploratory laparotomy and histopathological examination of tissue showed calcified granuloma. Ziehl-Neelsen staining and PCR confirmed the tuberculosis. The patient was successfully treated with standard antituberculosis therapy.

Download Full-text

A rare presentation of eyelid tuberculosis

Malaysian Journal of Ophthalmology ◽

10.35119/myjo.v1i4.3 ◽

2020 ◽

Vol 1 (4) ◽

pp. 284-288

Author(s):

Woon Tian Qing ◽

Noorlaila Bt Baharuddin ◽

Nor Fadzillah Bt Abd Jalil ◽

Raja Norliza Raja Omar ◽

Wan Haslina Wan Abdul Halim

Keyword(s):

Extrapulmonary Tuberculosis ◽

Excision Biopsy ◽

Diagnostic Challenge ◽

Rare Presentation ◽

Upper Eyelid ◽

Corrected Visual Acuity ◽

Insidious Onset ◽

History Of ◽

The Right ◽

Suspicious Case

Mycobacterium tuberculosis is transmitted through aerosolization, hence commonly infects the lungs. The occurrence of extrapulmonary tuberculosis is rare. We report a case of eyelid tuberculosis in a 45-year-old gentleman with a history of treated testicular tuberculosis three years ago. He had insidious onset of painless swelling in the right upper eyelid associated with erythema for one month. He did not have other constitutional symptoms. Initially, he was treated as chalazion and given topical antibiotics. However, the swelling worsened despite medication. His best corrected visual acuity was 6/9 in both eyes. Examination showed an elevated ulcerative growth with broad base which bled easily upon touch. The clinical presentation varies from an eyelid infection as an eyelid tumour can be a diagnostic challenge. A slow response to oral and topical antibiotic warrants an excision biopsy. The results showed chronic granulomatous infection in acid-fast bacilli. An antituberculosis (anti-TB) therapy was started and the patient showed a positive clinical response. Althrough rare, tuberculosis of eyelid should be considered as differential diagnosis of chalazion. Any suspicious case should be confirmed by biopsy followed by anti-TB if indicated.

Download Full-text