scholarly journals Choroidal Tuberculoma in a Healthy Immunocompetent Patient

2021 ◽  
Vol 13 (2) ◽  
pp. 202-206
Author(s):  
Hara Maya Gurung ◽  
Krishna Gurung ◽  
Anju Gurung ◽  
Indraman Maharjan ◽  
Eliya Shrestha ◽  
...  
Keyword(s):  
Rare Event ◽  
Immunocompetent Patient ◽  
Mantoux Test ◽  
Diagnostic Dilemma ◽  
Ocular Tuberculosis ◽  
Systemic Involvement ◽  
Chief Complaints ◽  
Laboratory Investigations ◽  
Choroidal Tuberculoma ◽  
Chorioretinal Scar

Introduction: Ocular tuberculosis as choroidal tuberculoma is a rare event. It creates a clinical diagnostic dilemma when there is no systemic involvement.  Case: A 22-year-old man  presented with the chief complaints of discomfort and blurring of vision of right eye for one week. On fundus examination under mydriatics of his right eye, a solitary mass which measured approximately 2DD (Disc Diameter) was appreciated at the superotemporal quadrant with the surrounding localized retinal detachment. Choroidal tuberculoma was suspected by a positive Mantoux test. Physician consultation and laboratory investigations ruled out the pulmonary and systemic manifestation of tuberculosis and other aetiology. Anti-tubercular treatment was started and this led to the improvement of vision and shrinkage of the choroidal mass into a flat chorioretinal scar at 3 months of anti-tubercular treatment .  Conclusion: Solitary choroidal tuberculoma though rare, can occur in a healthy, immunocompetent patient.

scholarly journals Ocular Tuberculosis with Multiple Cerebral Abscesses

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Saidin Nor-Masniwati ◽  
Embong Zunaina ◽  
Yaakub Azhany
Keyword(s):  
Maintenance Phase ◽  
Mantoux Test ◽  
Significant Finding ◽  
Ocular Tuberculosis ◽  
Night Sweats ◽  
Normal Chest ◽  
One Year ◽  
Loss Of Appetite ◽  
The Right ◽  
Choroidal Tuberculoma

A 23-year-old Malay man presented with headache for one-month duration. It was associated with painless blurring of vision of the right eye. He had loss of appetite and reduced weight but no night sweats or hemoptysis. His visual acuity on the right eye was 6/45 and improved to 6/15 with pinhole. Right fundus examination revealed a choroidal tuberculoma located at one disc diameter away from optic disc superiorly with mild vitritis. Systemic examinations revealed no significant finding. Mantoux test reading was 22 mm with erythrocyte sedimentation rate that was 14 mm/h. Other blood investigations were negative with normal chest radiography. The computerized tomography scan of the brain revealed multiple cerebral abscesses. A clinical diagnosis of right ocular tuberculosis with multiple cerebral abscesses was made. He was treated with antituberculosis chemotherapy for one year which divided into intensive phase for three months and maintenance phase for nine months. Cerebral abscesses resolved after three months of antituberculosis drugs and at one-year follow-up, and the choroidal tuberculoma resolved completely with scar formation and significant macular striae.

scholarly journals Managing solitary choroidal tuberculoma in an immunocompetent patient

2020 ◽  
Vol 10 (5) ◽  
pp. 124-125
Author(s):  
Abhinav Dhami ◽  
Nimrata bajaj Dhami ◽  
Ravinder kaur Malhi ◽  
Gobinder Singh Dhami
Keyword(s):  
Triamcinolone Acetonide ◽  
Oral Therapy ◽  
Subretinal Fluid ◽  
Visual Outcome ◽  
Immunocompetent Patient ◽  
Mantoux Test ◽  
Intravitreal Triamcinolone ◽  
Choroidal Granuloma ◽  
Anti Tubercular Therapy ◽  
Choroidal Tuberculoma

Aim: We describe a case of young immunocompetent 18-year-old female patient who presented with sudden painless diminution of vision in left eye with vision of 20/100 on Snellen’s chart. Retinal evaluation showed a massive solitary choroidal granuloma. A positive Mantoux test (20X20 mm) was noted. The patient was started on anti-tubercular therapy and oral steroids and showed resolution of the granuloma with subretinal fluid at macula. After 3 months of oral therapy, the persistent subretinal fluid was managed with intravitreal injection of triamcinolone acetonide(2 mg). This case highlights favorable resolution of granuloma with oral therapy and a safer efficacy of triamcinolone acetonide in treating subretinal fluid due to choroidal tuberculoma with good visual outcome. Introduction: Choroidal tuberculoma is a rare ocular form of tuberculosis (TB) and is a diagnostic and a therapeutic challenge, especially when occurring without other manifestations of the disease.1,2 Involvement of the choroid occurs by direct infection or indirect immune‐mediated hypersensitivity and is the commonest clinical manifestation of intraocular TB.3 The presentation varies from a solitary choroidal granuloma (tuberculoma) to multiple choroidal tubercles, a subretinal abscess or choroiditis. We present a case of an immunocompetent patient, who presents with massive choroidal granuloma and responded to oral antitubercular and steroid therapeutic regimen. Visual acuity improved with intravitreal triamcinolone acetonide injection which resulted in resolution of subretinal fluid after 3 months

scholarly journals The Diagnostic Conundrum of Retinitis and a Pigmented Scar

2021 ◽  
pp. 164-168
Author(s):  
Nikhila S. Khandwala ◽  
Jason M.L. Miller ◽  
Robert A. Hyde ◽  
Christopher D. Conrady ◽  
Rajesh C. Rao ◽  
...  
Keyword(s):  
Silicone Oil ◽  
Antiviral Agents ◽  
Retinal Vasculitis ◽  
Dual Therapy ◽  
Diagnostic Dilemma ◽  
Therapy Regimen ◽  
Oral Corticosteroids ◽  
Simplex Virus ◽  
Herpes Simplex Virus 2 ◽  
Chorioretinal Scar

We report a finding of a pigmented chorioretinal scar with acute retinal necrosis (ARN) caused by herpes simplex virus 2 (HSV-2) infection rather than toxoplasma, creating an initial diagnostic dilemma. A 53-year-old functionally monocular male presented with painless floaters and blurry vision in his seeing eye over a period of 4 days. An exam demonstrated anterior chamber (AC) reaction, vitritis, multifocal patches of whitening, and an occlusive retinal vasculitis. A superior pigmented chorioretinal scar with overlying contracted vitreous was noted in the periphery with no adjacent retinal whitening. The patient was treated for both ARN and toxoplasma chorioretinitis until PCR study of the vitreous and AC returned positive for HSV-2 and negative for toxoplasmosis. Management consisted of a dual therapy regimen of both oral and intravitreal antiviral agents as well as oral corticosteroids. The patient’s clinical course was complicated by rhegmatogenous retinal detachment within 2 weeks after symptom onset, requiring pars plana vitrectomy with silicone oil and intraoperative intraocular incubation with foscarnet. We review emerging evidence for pigmented chorioretinal scars in ARN specifically caused by HSV-2, as well as diagnostic and treatment dilemmas in the management of ARN and ARN detachments.

scholarly journals Extracranial metastases in secondary glioblastoma multiforme: a case report

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jessica Rossi ◽  
Lucia Giaccherini ◽  
Francesco Cavallieri ◽  
Manuela Napoli ◽  
Claudio Moratti ◽  
...  
Keyword(s):  
Brain Lesion ◽  
Rare Event ◽  
Subsequent Development ◽  
World Health ◽  
Who Grade ◽  
Systemic Involvement ◽  
Grade Ii ◽  
The Stability ◽  
Health Organization ◽  
Extracranial Metastases

Abstract Background Glioblastoma (GBM) is known for its devastating intracranial infiltration and its unfavorable prognosis, while extracranial involvement is a very rare event, more commonly attributed to IDH wild-type (primary) GBM evolution. Case presentation We present a case of a young woman with a World Health Organization (WHO) grade II Astrocytoma evolved to WHO grade IV IDH mutant glioblastoma, with subsequent development of lymphatic and bone metastases, despite the favorable biomolecular pattern and the stability of the primary brain lesion. Conclusions Our case highlights that grade II Astrocytoma may evolve to a GBM and rarely lead to a secondary metastatic diffusion, which can progress quite rapidly; any symptoms referable to a possible systemic involvement should be carefully investigated.

Disseminated rhinosporidiosis

2013 ◽  
Vol 127 (10) ◽  
pp. 1020-1024 ◽  
Author(s):  
S N Bandyopadhyay ◽  
S Das ◽  
T K Majhi ◽  
G Bandyopadhyay ◽  
D Roy
Keyword(s):  
Spontaneous Regression ◽  
Subcutaneous Tissue ◽  
Needle Aspiration ◽  
Immunocompetent Patient ◽  
Primary Lesion ◽  
Single Patient ◽  
Aspiration Cytology ◽  
Diagnostic Dilemma ◽  
Mucous Membranes ◽  
Needle Aspiration Cytology

AbstractIntroduction:Rhinosporidiosis primarily affects the mucous membranes of the nose and nasopharynx. The disseminated form of this chronic fungal disease is extremely rare.Case report:The authors present a case of disseminated rhinosporidiosis in an immunocompetent patient with involvement of the skin, subcutaneous tissue, muscle, bone, penis and urethra, and with a long-standing primary lesion in the nose.Discussion:A late or atypical presentation of rhinosporidiosis may cause diagnostic dilemma. Fine needle aspiration cytology of the tumoural lesions may establish the diagnosis. Histopathology is confirmatory. The subcutaneous masses may be solid or cystic. Ulceroproliferative lesions need to be differentiated from malignancies.Conclusion:This is the first reported case of truly disseminated rhinosporidiosis with simultaneous involvement of multiple anatomically unrelated sites in a single patient. This is also the first reported case of cystic rhinosporidiosis. The possibility and sequelae of spontaneous regression of rhinosporidiosis are also discussed.

scholarly journals GRANULOMATOUS MASTITIS IS NOT ALWAYS TUBERCULAR: ROLE OF FINE NEEDLE ASPIRATION CYTOLOGY IN EVALUATION OF GRANULOMATOUS MASTITIS

2019 ◽  
Vol 3 (12) ◽  
Author(s):  
Ridhima Auplish ◽  
Sneha Singh ◽  
Prem Singh ◽  
Shiv Pankaj Khanna ◽  
Aditi Gupta
Keyword(s):  
Malignant Tumors ◽  
Treatment Options ◽  
Mantoux Test ◽  
Granulomatous Mastitis ◽  
Diagnostic Dilemma ◽  
Idiopathic Granulomatous Mastitis ◽  
Caseous Necrosis ◽  
Study Results ◽  
Granulomatous Lesions ◽  
Tb Pcr

INTRODUCTION AND OBJECTIVES: Granulomatous mastitis is rare chronic inflammatory benign breast lesion, which clinically and radiologically resembles carcinoma breast thus creating a diagnostic dilemma. The term granulomatous mastitis includes two broad categories namely specific granulomatous mastitis for which aetiological factors can be defined such as infectious causes like Mycobacterium tuberculosis, blastomycosis, cryptococcosis, histoplasmosis, actinomycosis and filarial infection. Other factors include association with autoimmunue diseases such as Wegner’s  granulomatosis and giant cell arteritis and there are other rare causes such as include duct ectasia, foreign body reaction and fat necrosis which also leads to granulomatous lesions of breast. Cytological features of granulomatous mastitis(GM) have not been widely discussed and described in literature, so through this study we have made an attempt to thoroughly discuss cytological spectrum of granulomatous mastitis. MATERIALS AND METHODS: A retrospective study was performed over a period of four years from 2016 to 2019. A total of 465 cases of breast lump reported to cytopathology section out of which 24 cases of GM diagnosed on FNAC were included in our study. Results of Erythrocyte sedimentation rate (ESR) and Mantoux test along with TB-PCR were recorded. FNAC slides were retrieved pertaining to study period. Granulomatous lesions of breast were further categorized broadly into IGM/ NGM, granulomatous mastitis without caseous necrosis and tubercular mastitis where diagnosis were made definite on basis of demonstration of AFB or positive TB-PCR . RESULTS: Patient age ranged from 23 years to 55 years with the mean age of 36.6 years with maximum of patients falling in second decade followed by third decade. Granulomatous lesions were broadly categorized into Idiopathic/ Non specific granulomatous mastitis(11 cases,45.8%), GM with caseous necrosis(8 cases, 33.3%) and tubercular mastitis(5 cases, 20.9%). Histopathology was available in 7 cases(29.2%). TB-PCR was sent in all cases of granulomatous mastitis diagnosed on cytology and was positive in 10 cases(41.7%). CONCLUSION: Idiopathic granulomatous mastitis and tubercular mastitis are rare inflammatory diseases of breast which mimic malignancy clinically and radiologically. FNAC plays important role in diagnosis of granulomatous diseases of breast and also their differentiation from malignant tumors. Tubercular mastitis needs to be differentiated from IGM since treatment options are different in both the cases. Cytopathology plays an important role in differentiationg both the diseases supplemented by radiological and microbiological investigations.  The present study thus highlights the importance of FNAC as an infalliable tool in diagnosis of granulomatous mastitis and its differentiation from neoplastic lesions of breast thus avoiding time consuming histopathological work up of cases.

scholarly journals Endoscopic Aspects of Gastric Syphilis

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Mariana Souza Varella Frazão ◽  
Thiago Guimarães Vilaça ◽  
Fred Olavo Aragão Andrade Carneiro ◽  
Kengo Toma ◽  
Carolina Eliane Reina-Forster ◽  
...  
Keyword(s):  
Epigastric Pain ◽  
Treponema Pallidum ◽  
Rare Event ◽  
Immunocompetent Patient ◽  
Histopathological Analysis ◽  
Neoplastic Disease ◽  
Inflammatory Infiltration ◽  
Clinical Consultation ◽  
Gastric Biopsies ◽  
Low Incidence

Introduction. Considered as a rare event, gastric syphilis (GS) is reported as an organic form of involvement. Low incidence of GS emphasizes the importance of histopathological analysis.Objective. We aim to characterize GS endoscopic aspects in an immunocompetent patient.Case Report. A 23-year-old man presented with epigastric pain associated with nausea, anorexia, generalized malaise and 11 kg weight loss that started 1 month prior to his clinical consultation. Physical examination was normal except for mild abdominal tenderness in epigastrium. Endoscopy observed diminished gastric expandability and diffuse mucosal lesions, from cardia to pylorus. Gastric mucosa was thickened, friable, with nodular aspect, and associated with ulcers lesions. Gastric biopsies were performed, and histopathological analysis resulted in dense inflammatory infiltration rich in plasmocytes. Syphilis serologies were positive for VDRL andTreponema pallidumreagents. Immunohistochemical tests were positive forTreponema pallidumand CD138. The patient was treated with penicillin, leading to resolution of his clinical complaints and endoscopic findings.Conclusion. Diagnosis suspicion of GS is important in view of its nonspecific presentation. Patients with gastric symptoms that mimic neoplastic disease should be investigated thoroughly based on the fact that clinical, endoscopic, and histological findings can easily be mistaken for lymphoma or plastic linitis.

scholarly journals Abdominopelvic Tuberculosis Secondary to a Nontuberculous Mycobacterium in an Immunocompetent Patient

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Beng Kwang Ng ◽  
Kembang Aziah Yakob ◽  
Wendy Yin Ling Ng ◽  
Pei Shan Lim ◽  
Rahana Abd Rahman ◽  
...  
Keyword(s):  
Abdominal Cavity ◽  
Cystic Teratoma ◽  
Foreign Worker ◽  
Exploratory Laparotomy ◽  
Immunocompetent Patient ◽  
Nontuberculous Mycobacterium ◽  
Diagnostic Dilemma ◽  
Common Location ◽  
Intravenous Antibiotics ◽  
History Of

Tuberculosis (TB) remained as one of the top 10 causes of death worldwide despite an overall decline in its incidence rate globally. Extrapulmonary TB is uncommon and only accounts for 10–20% of overall TB disease burden. Abdominopelvic TB is the sixth most common location of extrapulmonary TB. The symptoms and signs are often insidious and nonspecific. Diagnosing abdominopelvic TB can be very challenging at times and poses great difficulties to the clinician. Infection with nontuberculous Mycobacterium (NTM) is even rarer especially in an immunocompetent patient. We report a case of NTM in abdominopelvic TB. A 37-year-old foreign worker, para 3, presented with a one-week history of suprapubic pain associated with fever. An assessment showed presence of a right adnexal mass. She was treated as tuboovarian abscess with intravenous antibiotics. Unfortunately, she did not respond. She underwent exploratory laparotomy. Intraoperatively, features of the mass were suggestive of a right mature cystic teratoma with presence of slough and cheesy materials all over the abdominal cavity as well as presence of ascites. Diagnosis of NTM was confirmed with PCR testing using the peritoneal fluid. This case was a diagnostic dilemma due to the nonspecific clinical presentation. Management of such rare infection was revisited.

scholarly journals Clinical profile of children with tuberculosis from a semi urban referral centre in South India: a prospective observational study

2019 ◽  
Vol 6 (4) ◽  
pp. 1450
Author(s):  
Anuradha G. ◽  
Muraleetharan G.
Keyword(s):  
Clinical Examination ◽  
Complete Blood Count ◽  
Childhood Tuberculosis ◽  
Diagnostic Methods ◽  
Clinical Profile ◽  
Mantoux Test ◽  
Presenting Symptoms ◽  
Bacteriological Diagnosis ◽  
Laboratory Investigations ◽  
Extra Pulmonary

Background: Global TB report 2018 reports that in India, an estimated 2.2 lakh children become ill with tuberculosis (TB) each year. In spite of new rapid diagnostic methods, lack of gold standard test for confirming childhood tuberculosis remains an obstacle for the effective reporting of childhood TB and hence these cases often remain under diagnosed. The main objective was to study the clinical profile of childhood tuberculosis with relevant laboratory investigations aiding in early diagnosis.Methods: A prospective observational hospital-based study was conducted in IRT-Perundurai medical college hospital from April 2016 to March 2018. Children less than 18 years of age with tuberculosis were included in the study. Demographic details, presenting symptoms, family history of TB contact, nutritional status and clinical examination findings were documented. Complete blood count, ESR, Mantoux test, chest X-ray and sputum analyses for AFB were done for all patients.Results: Out of the total 124 children studied, the most common age of presentation of tuberculosis was >10 years of age (n=58, (46.8%)). There was a female preponderance (n=71 (57.25%)). Pulmonary tuberculosis (n= 87, (70.16%)) was the most common form followed by extra pulmonary (n=32, (25.80%)) and disseminated type (n=5, (4%)).  Lymph node TB was the most common manifestation (n=20, 62.50%) among extra pulmonary form. Cough (n=75, 60.5%) with sputum (n=55,44.4%) were the predominant symptoms noted followed by fever (n=53, 42.7%). Bacteriological diagnosis was possible in 19.5% (n=17) patients only.Conclusions: This study reinforces that the diagnosis of childhood tuberculosis is based on the constellation of symptom evaluation, contact history, clinical examination, with relevant laboratory investigations.

scholarly journals Etiology of dizziness among patients referring to an Iranian ear, nose and throat clinic

2018 ◽  
Author(s):  
Masoumeh Saeedi ◽  
Mohammad Ajalloueyan ◽  
Farzaneh Zamiri Abdollahi ◽  
Mohammadreza Choobdari
Keyword(s):  
Endolymphatic Hydrops ◽  
The Elderly ◽  
Final Diagnosis ◽  
Emotional Reactions ◽  
Blood Analysis ◽  
Vestibular Evoked Myogenic Potentials ◽  
Emergency Rooms ◽  
Systemic Involvement ◽  
Chief Complaints ◽  
Comprehensive Evaluations

Background and Aim: Dizziness is one the most common complaints of patients in the emergency rooms. It has various etiologies and can lead to falling and other life-threatening injuries, especially in the elderly. Dizziness aff­ects the quality of life and results in negative emotional reactions. This research studied the etiology of dizziness in a three-year study. Methods: This study was conducted on 650 patients with the complaint of dizziness, whose specialists suspected them of having possible vestibular involvement, referred to a tertiary audiology clinic from 2015 to 2018. Videonys­tagmography, electrocochleography and cervical vestibular evoked myogenic potentials were administered. Other medical tests including neu­rologic examinations, blood analysis, and brain imaging were performed based on patients’ complaints. * Corresponding author: Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Piche-Shemiran, Enghelab Ave., Tehran, 1148965141, Iran. Tel: 009821-77530636, E-mail: [email protected]   Results: This was a descriptive study of dizzi­ness prevalence with different etiologies. Patie­nts’ age range was 18-85 years with mean (SD) age: 42.34 (13.12), including 377 (58%) females and 273 (42%) males. Patients’ chief complaints included vertigo in 64.8%, dizziness in 20.2% and imbalance in 15.1%. Vestibular disorders were identified in 49.2% of the referred patients. The patients’ final diagnosis in order of preva­lence were as follows: systemic involvement (292 cases), benign paroxysmal positional ver­tigo (187 cases), unilateral vestibular weakness (63 cases), endolymphatic hydrops (51 cases), bilateral vestibular weakness (37 cases), central involvement (20 cases), cervical (10 cases) and migraine-associated vertigo (8 cases). Conclusion: About 49.2% of the patients refe­rred to the ENT clinic had actual vestibular involvement. Careful history taking, teamwork, and comprehensive evaluations are necessary to differentiate underlying cause and selecting app­ropriate treatment.

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