Neurotuberculosis with intracerebral tuberculoma and PCR for detectable Mycobacterium in CSF

Introduction: Neurotuberculosis is the most serious form of extrapulmonary tuberculosis. The main clinical presentation is meningoencephalitis, which may be associated with tuberculomas. The detection of Mycobacterium tuberculosis by CSF in CSF is still a diagnostic challenge. Objectives: To report a clinical case of neurotuberculosis associated with intracranial tuberculoma with detection of Mycobacterium tuberculosis by CSF in CSF. Methods: Neurotuberculosis is the most serious form of extrapulmonary tuberculosis. The main clinical presentation is meningoencephalitis, which may be associated with tuberculomas. The detection of Mycobacterium tuberculosis by CSF in CSF is still a diagnostic challenge. Results: C. A. G., 45 years old, female, admitted to the hospital in January 2020, presenting holocranial, pulsatile headache, which had worsened for 5 days, with little response to analgesics, associated with an episode of tonic-clonic seizure crisis, without other clinical signs. Previous diagnosis of asthma, using continuously salbutamol and beclomethasone. Examinations were requested - BAAR search for positive sputum, rapid molecular sputum test revealing Mycobacterium tuberculosis, clear-looking CSF, detectable CRP for Mycobacterium tuberculosis, glucose 63, protein 56.3, total cytology 74 (35% neutrophils, 19% lymphocytes , 46% macrophages). The cranial tomography showed a nodular lesion in the corticosubcortical region of the left frontal lobe, with annular enhancement by means of contrast, measuring 3.9 x 3.9 cm, in addition to accentuated meningeal enhancement. Chest tomography showed hollowed-out lesions with thickened walls, with the appearance of a sprouting tree, predominating in the lower lobe of the right lung. The diagnoses of neurotuberculosis (cerebral tuberculoma and meningitis) and pulmonary tuberculosis were then established. Referred to the infectious disease referral hospital using RHZE associated with dexamethasone and phenytoin. After 48 hours of hospitalization, the patient evolved with confusion and mental disorientation, suspecting complex subentrant partial seizures with a confused post-ictal state. A new skull tomography was requested, which showed an expansive lesion with an ovoid aspect 4.5 x 3.3 cm with liquefied content and ring impregnation by means of contrast in the upper left frontal region with mass effect and significant perilesional edema. Electroencephalogram showed disorganized base activity, periodically, sometimes with three-phase morphology, sometimes acute, in both hemispheres, with greater projection to the left and epileptiform activity also in the frontal- temporal region, bilaterally and independently. After therapeutic adjustment, the patient remained clinically stable and was discharged from the hospital with outpatient followup due to infectious diseases and neurology. Conclusion: The case addressed draws attention to the different neurological manifestations observed in neurotuberculosis, such as headache, seizures, confusion and disorientation. Early diagnosis and treatment is important to achieve a favorable outcome.

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Tuberculosis in Otorhinolaryngology: Clinical Presentation and Diagnostic Challenges

International Journal of Otolaryngology ◽

10.1155/2011/686894 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 11

Author(s):

Rajiv C. Michael ◽

Joy S. Michael

Keyword(s):

Mycobacterium Tuberculosis ◽

Pulmonary Tuberculosis ◽

Clinical Presentation ◽

Extrapulmonary Tuberculosis ◽

Common Type ◽

The Body ◽

Diagnostic Challenge ◽

Cervical Adenitis ◽

Important Form

Tuberculosis affects all tissues of the body, although some more commonly than the others. Pulmonary tuberculosis is the most common type of tuberculosis accounting for approximately 80% of the tuberculosis cases. Tuberculosis of the otorhinolaryngeal region is one of the rarer forms of extrapulmonary tuberculosis but still poses a significant clinical and diagnostic challenge. Over three years, only five out of 121 patients suspected to have tuberculosis of the otorhinolaryngeal region (cervical adenitis excluded) hadMycobacterium tuberculosisculture-proven disease. Additional 7 had histology-proven tuberculosis. Only one patient had concomitant sputum-positive pulmonary tuberculosis. We look at the various clinical and laboratory aspects of tuberculosis of the otorhinolaryngeal region that would help to diagnose this uncommon but important form of extrapulmonary tuberculosis.

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A Stratified Approach for Cushing’s Syndrome Diagnosis

Global Journal of Health Science ◽

10.5539/gjhs.v11n10p55 ◽

2019 ◽

Vol 11 (10) ◽

pp. 55

Author(s):

Mervin Chavez ◽

Joselyn Rojas ◽

Miguel Aguirre ◽

Marjorie Villalobos ◽

Juan Salazar ◽

...

Keyword(s):

Clinical Presentation ◽

Clinical Signs ◽

Signs And Symptoms ◽

Proximal Muscle ◽

Diagnostic Challenge ◽

Adequate Treatment ◽

Primary Origin ◽

Cutaneous Atrophy ◽

Buffalo Hump

Cushing’s syndrome is an endocrine disorder broadly renowned as a diagnostic challenge. From the initial clinical presentation up to the identification of the underlying etiology, it is necessary to adhere to a logical and stratified plan of action, directed to the correlation of signs and symptoms to the physiopathology of the syndrome, in order to accurately establish a diagnosis and adequate treatment. From stages as early as the patient’s first clinical evaluation, the physician should be specially attentive of a constellation of clinical signs which strongly suggest the diagnosis of Cushing’s syndrome, such as the presence of a “moon face”, a “buffalo hump”, cutaneous atrophy, proximal muscle weakness and purplish cutaneous striae, among others. Based off these findings, laboratory analyses are necessary for the detection of hypercortisolism. According to these results, and if physiologic causes are ruled out, pathologic hypercortisolism is confirmed. Lastly, a complex array of diagnostic tests must be navigated to identify the primary origin of the disorder. Thus, the diagnosis of Cushing’s syndrome requires a logically structured algorithm of action, constructed off its pathophysiologic implications, in order to optimize time, resources and the interdisciplinary workgroup required for its consecution, and offer patients the possibility of a better quality of life. It is also important to highlight the need for a stratified approach in patients with metabolic disturbance given that medical professionals may simply treat the patient for obesity not recognizing the presence of the complicating condition Cushing’s syndrome.

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Peritoneal Tuberculosis: A Forsaken Yet Misleading Diagnosis

Case Reports in Oncological Medicine ◽

10.1155/2019/5357049 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Joseph Kattan ◽

Fady Gh. Haddad ◽

Lina Menassa-Moussa ◽

Carole Kesrouani ◽

Stephanie Daccache ◽

...

Keyword(s):

Ovarian Cancer ◽

Mycobacterium Tuberculosis ◽

Ct Scan ◽

Peritoneal Carcinomatosis ◽

Respiratory Symptoms ◽

Clinical Presentation ◽

Abdominal Mass ◽

Extrapulmonary Tuberculosis ◽

Abdominal Distension ◽

Peritoneal Tuberculosis

In women presenting with an abdominal mass and ascites, the first diagnosis to consider is ovarian cancer. However, clinicians should always consider alternative differentials, namely, peritoneal tuberculosis, especially in the presence of respiratory symptoms and with the increasing prevalence of extrapulmonary tuberculosis. Peritoneal tuberculosis can mimic the clinical presentation of ovarian cancer, and on imaging, it can show similar features of peritoneal carcinomatosis and nodules. Tumor markers can also be elevated in the absence of malignancy. We present the case of a 44-year-old woman with abdominal distension and ascites. Imaging with CT scan, MRI, and PET scan were inconclusive, showing peritoneal nodules. Cytology of ascites was negative. Laparoscopy was done showing Koch bacilli followed by pulmonary sampling showing Mycobacterium tuberculosis. The patient was treated with quadritherapy with resolution of symptoms.

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Unusual Pneumonia Mimic

European Journal of Case Reports in Internal Medicine ◽

10.12890/2019_001181 ◽

2019 ◽

Author(s):

Joana Ricardo Pires ◽

Maria José Moreira ◽

Margarida Martins ◽

Clarinda Neves

Keyword(s):

Clinical Presentation ◽

Lower Lobe ◽

Community Acquired Pneumonia ◽

Diagnostic Challenge ◽

X Ray ◽

Severe Hypoxaemia ◽

Chest X Ray ◽

The Right ◽

High Index Of Suspicion ◽

Exploratory Laparoscopy

Disease in atypical organ locations can mimic other pathologies, hampering the right diagnosis. Such conditions may even be emergencies, like appendicitis. Subhepatic appendix is a very rare entity which may be caused by caecum dehiscence failure. The authors present the case of a 55-year-old immunocompetent man admitted to the Emergency Department with sepsis and severe hypoxaemia. Chest x-ray showed right lower lobe infiltrate, and community-acquired pneumonia was diagnosed. The patient was started on broad-spectrum antibiotics, but he continued to deteriorate and after 3 days developed abdominal complaints. Exploratory laparoscopy revealed an abscess caused by perforated subhepatic appendicitis. Subhepatic appendicitis presents a diagnostic challenge and its clinical presentation may mimic that of other entities. This case highlights an atypical presentation, where the early development of inflammatory lung injury mimicked common pneumonia. Maintenance of a high index of suspicion and knowledge of these atypical locations is crucial.

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Verrucous lesion over the foot: a diagnostic challenge

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20195686 ◽

2019 ◽

Vol 6 (1) ◽

pp. 118

Author(s):

Anil P. Gosavi ◽

Ravindranath B. Chavan ◽

Nitika S. Deshmukh ◽

Shishir Khose ◽

Darshana R. Kundale ◽

...

Keyword(s):

Mycobacterium Tuberculosis ◽

Male Patient ◽

Inflammatory Reaction ◽

Small Proportion ◽

Extrapulmonary Tuberculosis ◽

Diagnostic Challenge ◽

Cutaneous Tuberculosis ◽

Rare Manifestation

Infection with <em>Mycobacterium tuberculosis </em>or other very closely related strains, as well as the inflammatory reaction of the host, define the disease tuberculosis. Cutaneous tuberculosis constitutes a small proportion of extrapulmonary tuberculosis. Extensive, multifocal involvement of cutaneous tuberculosis is a rare manifestation. We report one such case of tuberculosis verrucosa cutis in a 24 year old immunocompetent male patient.

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Surgical management of choke through oesophagotomy in a buffalo: A case report

THE INDIAN JOURNAL OF VETERINARY SCIENCES AND BIOTECHNOLOGY ◽

10.21887/ijvsbt.v12i3.7098 ◽

2017 ◽

Vol 12 (3) ◽

Author(s):

Devasee Borakhatariya ◽

A. B. Gadara

Keyword(s):

Case Report ◽

Surgical Management ◽

Clinical Presentation ◽

Clinical Signs ◽

Thoracic Inlet ◽

Cervical Oesophagus ◽

Foreign Objects ◽

History Of ◽

Oesophageal Obstruction ◽

Large Animals

Oesophageal disorders are relatively uncommon in large animals. Oesophageal obstruction is the most frequently encountered clinical presentation in bovine and it may be intraluminal or extra luminal (Haven, 1990). Intraluminal obstruction or “choke” is the most common abnormality that usually occurs when foreign objects, large feedstuff, medicated boluses, trichobezoars, or oesophageal granuloma lodge in the lumen of the oesophagus. Oesophageal obstructions in bovine commonly occur at the pharynx, the cranial aspect of the cervical oesophagus, the thoracic inlet, or the base of the heart (Choudhary et al., 2010). Diagnosis of such problem depends on the history of eating particular foodstuff and clinical signs as bloat, tenesmus, retching, and salivation

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Hyperbaric oxygen therapy in the treatment of malign edema complication after arteriovenous malformation radiosurgery

Undersea and Hyperbaric Medicine ◽

10.22462/10.12.2019.18 ◽

2019 ◽

pp. 713-717

Keyword(s):

Arteriovenous Malformation ◽

Hyperbaric Oxygen ◽

Vasogenic Edema ◽

Mass Effect ◽

Radiological Examination ◽

Temporal Region ◽

Left Frontal Lobe ◽

Steroid Resistant ◽

Alternative Treatment Option ◽

Martin Grade

A 16-year-old female patient with headache was admitted to our hospital. Radiological examination showed a Spetzler- Martin Grade III arteriovenous malformation (AVM) located at the left frontal lobe. Volume-staged stereotactic radiosurgery (SRS) treatment performed in two fractions at three-month intervals and post-procedural period were uneventful. Eight months later the patient was admitted to our hospital with headache, vomiting, right-sided facial palsy and right upper extremity paresthesia. Radiological examination demonstrated severe vasogenic edema in the left centrum semiovale and temporal region. Due to severe and steroid-resistant malign edema, hyperbaric oxygen (HBO2) therapy was performed as an alternative treatment option. Neurological symptoms resolved completely after HBO2. Radiological examination demonstrated serious improvement of brain edema and mass effect.

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Investigation of an EHV-1 Outbreak in the United States Caused by a New H752 Genotype

Pathogens ◽

10.3390/pathogens10060747 ◽

2021 ◽

Vol 10 (6) ◽

pp. 747

Author(s):

Nicola Pusterla ◽

Samantha Barnum ◽

Julia Miller ◽

Sarah Varnell ◽

Barbara Dallap-Schaer ◽

...

Keyword(s):

Early Stage ◽

Clinical Signs ◽

Amino Acid Position ◽

High Viral Load ◽

The United States ◽

Neurological Deficits ◽

Diagnostic Challenge ◽

Genotype I ◽

Flunixin Meglumine ◽

Nasal Secretions

Here we report on an EHV-1 outbreak investigation caused by a novel genotype H752 (histidine in amino acid position 752 of the ORF 30 gene). The outbreak involved 31 performance horses. Horses were monitored over a period of 35 days for clinical signs, therapeutic outcome and qPCR results of EHV-1 in blood and nasal secretions. The morbidity of the EHV-1 outbreak was 84% with 26 clinically infected horses displaying fever and less frequently anorexia and distal limb edema. Four horses showed mild transient neurological deficits. Clinically diseased horses experienced high viral load of EHV-1 in blood and/or nasal secretions via qPCR, while subclinically infected horses had detectable EHV-1 mainly in nasal secretions. The majority of infected horses showed a rise in antibody titers to EHV-1 during the outbreak. All 31 horses were treated with valacyclovir, while clinically infected horses further received flunixin meglumine and sodium heparin. This investigation highlights various relevant aspects of an EHV-1 outbreak caused by a new H752 genotype: (i) importance of early detection of EHV-1 infection; (ii) diagnostic challenge to assess H752 genotype; (iii) apparent benefit of valacyclovir use in the early stage of the outbreak; and (iv) weekly testing of blood and nasal secretions by qPCR in order to monitor individual infection status and lift quarantine.

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A novel de novo DDX3X missense variant in a female with brachycephaly and intellectual disability: a case report

Italian Journal of Pediatrics ◽

10.1186/s13052-021-01033-4 ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

Giada Moresco ◽

Jole Costanza ◽

Carlo Santaniello ◽

Ornella Rondinone ◽

Federico Grilli ◽

...

Keyword(s):

Intellectual Disability ◽

Clinical Presentation ◽

De Novo ◽

Clinical Signs ◽

Missense Variant ◽

Psychomotor Development ◽

Helicase Domain ◽

Protein Activity ◽

Mrna Metabolism ◽

Pathogenic Variants

Abstract Background De novo pathogenic variants in the DDX3X gene are reported to account for 1–3% of unexplained intellectual disability (ID) in females, leading to the rare disease known as DDX3X syndrome (MRXSSB, OMIM #300958). Besides ID, these patients manifest a variable clinical presentation, which includes neurological and behavioral defects, and abnormal brain MRIs. Case presentation We report a 10-year-old girl affected by delayed psychomotor development, delayed myelination, and polymicrogyria (PMG). We identified a novel de novo missense mutation in the DDX3X gene (c.625C > G) by whole exome sequencing (WES). The DDX3X gene encodes a DEAD-box ATP-dependent RNA-helicase broadly implicated in gene expression through regulation of mRNA metabolism. The identified mutation is located just upstream the helicase domain and is suggested to impair the protein activity, thus resulting in the altered translation of DDX3X-dependent mRNAs. The proband, presenting with the typical PMG phenotype related to the syndrome, does not show other clinical signs frequently reported in presence of missense DDX3X mutations that are associated with a most severe clinical presentation. In addition, she has brachycephaly, never described in female DDX3X patients, and macroglossia, that has never been associated with the syndrome. Conclusions This case expands the knowledge of DDX3X pathogenic variants and the associated DDX3X syndrome phenotypic spectrum.

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