Tubercular Mycotic Aortic Aneurysm: Complication of Tubercular Spondylodiscitis due to Treatment Default

We have reported rare case of tubercular aortic aneurysm which has developed as complication of spinal tuberculosis. Imaging of patient is available prior to starting of antitubercular treatment which showed vertebral tuberculosis with absence of aortic aneurysm. However, patient defaulted on treatment after taking antitubercular chemotherapy only for 2 months. Patient again reported after 14 months with chest pain. At this stage, imaging showed progression of spinal tuberculosis with development of pseudoaneurysm in adjacent descending thoracic aorta. This contiguous spread of tuberculosis from spine to aorta may have been prevented if patient had completed complete course of antitubercular therapy with regular follow-ups. Patient of spinal tuberculosis need to be counselled and informed regarding its various complications, so that they remain adhered to antitubercular chemotherapy and timely follow-ups to prevent complications.

Spinal intramedullary tuberculoma in a 3-year-old girl

Background: Spinal intramedullary tuberculoma (IMT) is a rare manifestation of extrapulmonary tuberculosis (TB). Presentation of TB in the pediatric age group is a significant contributor to mortality. Case Description: A young vaccinated girl presented to the neurosurgery department with difficulty walking and urinary incontinence. A magnetic resonance imaging performed outside the hospital showed a hyperintense intramedullary lesion extending from T6 to T9. The patient underwent T6–T9 laminoplasty with intramedullary lesion decompression under neuromonitoring. The dense adherence of the lesion to the cord and nerve roots permitted only debulking. Histopathological examination confirmed the diagnosis of tuberculoma. The patient was started on antitubercular treatment and was then subsequently discharged. After 8 months, the patient was reviewed and showed improvement in her symptoms and complete resolution of the lesion on imaging. The patient has now developed hydrocephalus on the latest computed tomography imaging, which may be due to tubercular meningitis or arachnoiditis. Conclusion: Complete resolution of spinal IMT is possible with a combined treatment approach.

Primary leptomeningeal lymphoma masquerading as infectious tubercular meningitis

Primary central nervous system lymphoma (PCNSL) is infrequent and often poses diagnostic conundrums due to its protean manifestations. We present the case of a South Asian young man presenting with raised intracranial pressure and a lymphocytic cerebrospinal fluid (CSF) with pronounced hypoglycorrhachia. Progression of the neuro-ophthalmic signs while on early stages of antitubercular treatment led to additional investigations that produced a final diagnosis of primary leptomeningeal lymphoma. Treatment with chemoimmunotherapy (methotrexate, cytarabine, thiotepa and rituximab (MATRix)) achieved full radiological remission followed by successful autologous transplant. This case highlights the difficulties and diagnostic dilemmas when PCNSL presents as a chronic meningeal infiltrative process. While contextually this CSF is most often indicative of central nervous system tuberculosis and justifies empirical treatment initiation alone, it is essential to include differential diagnoses in the investigation work-up, which also carry poor prognosis without timely treatment. High suspicion, multidisciplinary collaboration and appropriate CSF analysis were the key for a correct diagnosis.

Presternal Scrofuloderma: Tip of the Iceberg Unveiling Multifocal Extrapulmonary Tuberculosis - A Rare Case Report

Introduction: Scrofuloderma, a type of secondary cutaneous tuberculosis (TB) commonly arising from the underlying cervical or axillary lymph node foci via contiguity, is frequent in the pediatric population. The origin of scrofuloderma from the underlying sternal tubercular osteomyelitic focus is exceptionally unusual. It can rarely be a part of the convoluted riddle of multifocal TB, particularly in the setting of human immunodeficiency virus (HIV) infection. Case Presentation: We hereby report a 16-year-old immunocompetent female who presented with chronic, sinus-like lesions with bridging scars on the upper chest, clinically confounded with infected keloid and deep fungal infection. She was later diagnosed with scrofuloderma arising from sternal osteomyelitis compounded with multifocal tuberculosis (sternal, mediastinal, cutaneous, lumbar vertebral) and received antitubercular treatment. Conclusions: This case highlights the importance of harboring clinical scepticism supported by thorough systemic investigations while diagnosing these innocuous mimickers occurring at rare sites, even in immunocompetent individuals.

Case Report: A Case of Tuberculosis with Psoriasiform Lichen Scrofulosorum Exhibiting Koebner’s Phenomenon followed by Scrofuloderma

Lichen scrofulosorum is the most common tuberculid in the Indian population and the second most common form of cutaneous tuberculosis. We discuss an uncommon presentation of lichen scrofulosorum, with psoriasiform morphology and koebnerization at tuberculin test site, associated with cervical lymphadenitis in a 17-year-old girl. Although the cutaneous lesions resolved completely after 3 months of antitubercular treatment (ATT), she developed scrofuloderma in the left cervical region at 4 months. In the absence of rifampicin resistance, ATT was continued for another 6 months, with no further evidence of disease activity. This case represents an infrequent occurrence of lichen scrofulosorum followed by scrofuloderma, which necessitated a prolonged course of first-line ATT.

Adverse Drug Reactions Monitoring in Patients on Antitubercular Treatment in Tertiary Care Hospital, Mandya

Background: Tuberculosis is one of the major public health concerns in India. Treatment of tuberculosis need multidrug combinations, which is associated with increased incidence of adverse drug reactions (ADRs). Hence there is a need of active monitoring for adverse effects in patients who are on antitubercular treatment (ATT). Objectives: To study the pattern of ADRs caused by antitubercular drugs and to assess causality, severity and predisposing factors. Methodology: A prospective observational study was conducted for 6 months in tertiary care hospital of Mandya. A total of 74 patients of tuberculosis who experienced ADRs were included in the study after obtaining informed consent. Their demographic, treatment and ADR data were collected and analysed. Causality was assessed using WHO scale and Naranjo’s algorithm, whereas severity was assessed by Modified Hartwig and Siegel scale. Results: Among 74 patients, 55(74.32%) were males and 19 (25.67%) were females. A total of 86 ADRs were recorded amongst 74 patients, as 11 patients experienced two ADRs. During intensive and continuation phase of treatment, 65 (87.63%) and 9 (12.16%)patients experienced ADRs respectively. Gastrointestinal side effects and hepatotoxicity were the most frequently observed ADRs with 23 (26.7%) each, followed by pruritus and rashes in 18 (20.93%) patients.63.51% of ADRs had an association with fixed dose combination (FDC) of isoniazid, rifampicin, pyrazinamide and ethambutol. As per WHO scale and Naranjo’s algorithm majority of ADRs were probable with 44 (59.45%) and 58 (78.37%) respectively. Most of the ADRs belonged to mild (67.56%) category as per Modified Hartwig and Siegel scale. Conclusion: ADRs induced by ATT are common. Hence counselling of patients regarding their life style along with early detection and management will minimize the occurrence of ADRs and improvethe adherence to treatment.

Plants as Potential Antimycobacterial Agents and their various Screening Methods

Tuberculosis (TB) remains a threat to the human health worldwide. It causes mortality and morbidity in malnutrition and immunodeficient persons. It is an airborne infection which spreads from human to human through coughing and sneezing. The resistance development and the drug related toxicities associated with the current antitubercular treatment often necessitate the researchers to develop a new candidate for the treatment of tuberculosis. The selection of a feasible and reproducible method for the screening of new bioactive compounds in a high throughput method is necessary to find a hit from the list of compounds. Plants are the rich source of bioactive compounds and found their wide application globally for their medicinal properties since ancient times. The change of an era from antibiotics to phytomedicines certainly minimizes the difficulty of drug resistance and drug related toxicities. This review highlights the screening methods for the development of candidates against M. tuberculosis to understand the potential of various plant species reported to be active against various mycobacterial strains.

Pulmonary Koch in 4 Months Old: Congenital or Acquired?

4 months old female child presented to us with complaints of fever, cough, cold, and poor weight gain. On examination the child had failure to thrive (weight 2.75kg, length 52cms, head circumference 35cms, weight for length <-3SD), cachexic look, severe respiratory distress (bilateral chest retractions and nasal flaring), hepatosplenomegaly, delayed milestones with low birth weight (2.07kg), continuous low grade fever. Mother was an open case of pulmonary Koch, taking antitubercular treatment since 6 months. Investigations revealed anemia, neutrophilia with reactive CRP, raised transaminases, pulmonary fibrosis and cavitary lesions in chest x-ray with normal CSF examination. Mantoux was reactive with gastric aspirate and cerebrospinal fluid negative for TB bacilli in GeneXpert. So the question arises, is it congenital or acquired? Key words: congenital TB, hepatosplenomegaly, respiratory distress, failure to thrive.

Isoniazid Induced Unilateral Gynecomastia: A Rare Case Report

Gynecomastia refers to glandular enlargement of male breast. It can be physiological, pathological, pharmacological and idiopathic. The present case report describes a case of isoniazid induced gynecomastia. Keywords: Gynecomastia, antitubercular treatment (ATT), isoniazid.

Case of melioidosis misdiagnosed as pulmonary tuberculosis

Melioidosis is an endemic infection caused by Burkholderia pseudomallei predominantly reported in the coastal parts of India. A 19-year-old male student with no comorbidities presented with features suggestive of pneumonia. He was initiated on antitubercular treatment empirically elsewhere. However, due to lack of response to therapy diagnosis was revisited. Microbiological investigations were unyielding initially. Despite antitubercular treatment, he presented with complications of pneumonia and was diagnosed to have melioidosis. He was initiated on appropriate antibiotics for the intensive and eradication phase. Obtaining microbiological confirmation is of utmost importance to prevent misdiagnosis and undue morbidity and mortality due to these uncommon infections.