Abdominal cyst of unclear aetiology: gastrointestinal stromal tumour or reactivation of abdominal tuberculosis

Differential diagnosis of a new abdominal mass is broad and includes infection, malignancy and other inflammatory processes. Definitive diagnosis may be challenging without invasive biopsy, as history, physical exam and imaging may be non-specific. A 69-year-old man with a history of abdominal tuberculosis presented with a new painful abdominal cyst consistent with reactivation of tuberculosis versus new malignancy. Investigations revealed 4+ acid-fast bacilli from the aspirate suggestive of tuberculosis, but no improvement was noted on antituberculous therapy. Core needle biopsy noted c-KIT-positive spindle cells, diagnostic for a gastrointestinal stromal tumour, while cultures grew non-tuberculous mycobacteria.

ANCA associated glomerulonephritis in tuberculosis: a paradoxical reaction

We present a case of antineutrophil cytoplasmic antibodies (ANCA)-associated rapidly progressive glomerulonephritis in the context of treatment of pulmonary tuberculosis (TB). A 42-year-old woman was treated for drug-susceptible pulmonary TB and represented with paradoxical worsening of symptoms and radiological features. She was HIV negative. A severe acute kidney injury with features of glomerulonephritis was evident on admission. Perinuclear ANCA and antimyeloperoxidase antibodies were present in serum and renal biopsy was consistent with ANCA-associated vasculitis. The patient was successfully treated with both antituberculous therapy and immunosuppression (corticosteroids and mycophenolate mofetil) with subsequent clinical improvement and amelioration of renal function. We propose this is the first case that describes the association between paradoxical reactions during TB treatment and ANCA-associated glomerulonephritis.

Pott’s Disease with Incidentally Discovered Multiple Brain Tuberculomas in a Previously Healthy 10-Year-Old Girl

Pott’s disease (PD) represents the most common form of spinal tuberculosis. Its association with brain tuberculomas is extremely rare. Herein, we report a previously healthy child with PD and concurrent multiple brain tuberculomas who was successfully treated with antituberculous therapy, surgical drainage of the paravertebral abscess, and adjuvant steroid therapy.

Beware of Drug Interactions Treating Iatrogenic Mycobacterium bovis Endocarditis from Intravesical BCG Instillation

We report a case of mechanical mitral valve endocarditis associated with miliary disseminated bacillus Calmette-Guerin (BCG) infection following intravesical instillations for minimally invasive bladder cancer in a 65-year-old man. The diagnosis was established by echocardiographic evidence of vegetation on the prosthetic mitral valve, miliary lesions in the lungs and evidence of bloodstream infection sustained by Mycobacterium. We successfully treated the patient with the classical regimen of quadruple antituberculous therapy.

Intramedullary Conus Medullaris Tuberculoma: A Case Report and Review of the Literature

Intramedullary tuberculoma (IMT) of the conus medullaris is extremely rare. We present a case of intramedullary conus medullaris tuberculoma in which the diagnosis was based on there being very high levels of adenosine deaminase (ADA) in the patient’s cerebrospinal fluid (CSF) and improvement with antituberculous therapy. A 78-year-old man presented after having had a dull ache in both thighs and progressive paraparesis. The patient’s medical history included diffuse large B-cell lymphoma, which had undergone remission due to chemotherapy two years earlier, and long-term, well-controlled diabetes. A chest X-ray showed no evidence of tuberculosis. The results of CSF analysis were compatible with Froin’s syndrome. An initial diagnosis was made of an intramedullary tumor of the conus medullaris, based on magnetic resonance imaging (MRI). A myelotomy and multiple punch out biopsy were performed, and histopathology of the tissues revealed mild reactive gliosis. Due to the patient having high levels of CSF-ADA, IMT of the conus medullaris was suspected. The patient was treated with an 18-month course of antituberculous therapy. The dull ache gradually disappeared, and motor power improved slightly. A follow-up MRI of the lumbosacral (LS) spine revealed that the lesion had completely disappeared. Intramedullary tuberculoma of the conus medullaris should be considered in patients with underlying malignancy and no symptoms of systemic tuberculosis. CSF adenosine deaminase levels can be helpful in determining the presence of central nervous system tuberculosis when other systemic signs of disease are lacking.

A Rare Case of Parotid Gland Tuberculosis

Parotid gland tuberculosis is a very rare form of extrapulmonary tuberculosis, with less than 200 cases reported in literature. We describe a 10-year-old female who presented with a swelling in the left parotid region during the last month. CT scan neck revealed an abscess in the left parotid gland extending into the submandibular gland, muscles, and bone. Pus aspirated by FNAC showed acid fast bacilli in the ZN stain, and GeneXpert was positive for rifampicin-sensitive Mycobacterium tuberculosis. She was successfully treated with antituberculous therapy given for 6 months. Parotid gland tuberculosis, although rare, has a good prognosis with drug therapy. Surgery is rarely required.

Caries Spine: A Comparative Study between Medical Management Alone with Combined Medical and Surgical Management

Objective: To compare short term outcome of combined surgical and medical management versus medical management alone in caries spine.Material and Methods: This study was conducted from August 2015 to August 2018, on 68 patients randomly divided into two groups of 34 each. All were diagnosed cases of Caries spine based on history, clinical examination, ESR and imaging appearances. Group A underwent surgical intervention along with Anti-Tuberculous Treatment (ATT) while Group B received medical treatment (ATT) alone. Results: There were 37 (54.41%) males and 31 (45.59%) females with mean age of 34.84 ± 10.6 years. The thoracic spine was the commonest site in 33 (48.5%) patients, followed by lumbar in 20 (20.8%), dorso-lumbar in seven (10.3%) and cervical in four (5.88%) patients. The ESR fell from 85mm/hr to 24.46mm/hr in Group A and to 41.92mm/hr in Group B (p = 0.0124). Overall improvement in Frankel grade was seen in 25 (73.5%) patients in Group A and 12 (35.3%) in group B. In group A, improvement seen from grade A in two (8%), grade B in three (12%), grade C in 12(48%), Grade D in seven (28%) patients, (p = 0.000) while eight (23.5%) patients remained same and only one (2.5%) deteriorated from baseline neurological status. In Group B, 16 (47%) patients remained same and six (17.6%) deteriorated. Conclusion: Surgery combined with antituberculous therapy was found to be beneficial in patients suffering from caries spine and to be recommended to patients desiring rapid recovery

Verrucous Psoriasis Successfully Treated with Ixekizumab: A Case Report with Review Literature

Verrucous psoriasis is a rare variant of plaque-type psoriasis with only about 35 cases reported. The authors reported a man with a history of psoriasis vulgaris for seven years, presented with progressive verrucous hyperkeratotic plaques on both legs for three years. His earlier investigations favored the diagnosis of tuberculosis verrucosa cutis. After completing the antituberculous therapy, the lesions persisted. The later investigations favored a rare subtype of psoriasis named verrucous psoriasis. Keywords: Verrucous psoriasis, Tuberculosis verrucosa cutis, Mycobacterium tuberculosis, Ixekixumab

Standardized approaches for clinical sampling and endpoint ascertainment in tuberculous meningitis studies

Tuberculous meningitis (TBM), the most severe manifestation of tuberculosis, has poorly understood immunopathology and high mortality and morbidity despite antituberculous therapy. This calls for accelerated clinical and basic science research in this field. As TBM disproportionally affects poorer communities, studies are often performed in resource-limited environments, creating challenges for data collection and harmonisation. Comparison of TBM studies has been hampered by variation in sampling strategies, study design and choice of study endpoints. Based on literature review and expert consensus, this paper provides firstly, practical recommendations to enable thorough diagnostic, pathophysiological and pharmacokinetic studies using clinical samples, and facilitates better data aggregation and comparisons across populations and settings. Secondly, we discuss clinically relevant study endpoints, including neuroimaging, functional outcome, and cause of death, with suggestions of how these could be applied in different designs for future TBM studies.