Single cervical spinal extramedullary tuberculous lesion in a young female – case report

Skeletal tuberculosis is the main extrapulmonary site for Mycobacterium tuberculosis infection disemination. As for the nervous sistem tuberculosis or spinal tuberculous disease in particular, the osseos elements are more frequently involved than the cerebral tissue or the spinal cord. We present the case of a previously healthy 32 year old female with no known TB history, reffered to our clinic for neck pain thought to be due to degenerative spinal disc disease. In the absence of general signs of the disease, the right surgical management and biopsy were the key factors for corect diagnosis.

Tuberculosis Diagnostics and Susceptibility in Saudi Arabia’s Western Region

Introduction: Saudi Arabia has a moderate infection rate of tuberculosis (TB) in comparison to other countries in the region. The prevalence of TB varies among different parts of the Kingdom, with its western provinces reporting to have the leading rate of incidence. Method : In this retrospective study, Acid-fast bacilli smear (AFB), and nucleic acid amplification test (NAAT) were performed on all positive cultures from 254 identified TB cases from November 2006 to August 2016 in King Faisal Specialist Hospital and Research Center – Jeddah, Saudi Arabia. Results: From the positive cultures for Mycobacterium tuberculosis complex, 99.1% were found to be positive by using NAAT. From the NAAT positive samples, only 36.8% were positive for AFB. TB was predominant among the younger age group (59.4%) compared to the elderly population (35.8%) and pediatrics (4.7%), and it was also observed that males had a higher prevalence of 56.3 % in comparison to females. In regards to the site of infection, 53.1 % were pulmonary and 46.9% from an extrapulmonary. It was noted that resistance to first-line anti-TB drugs individually was found to be 11.0% to Streptomycin, 10.2% to isoniazid, 5.1% to pyrazinamide, 2.4% to Rifampicin, and 1.2% Ethambutol, yet multi-drug resistance (MDR) was found in 2.4% of observed cases. Conclusion: Young age predominance, low direct smear positivity, increased incidence of the extrapulmonary site of infection, and re-emergence of TB resistance all were observed in our study compared to previous national surveys.

Genitourinary tuberculosis masquerading as a ureteral calculus

The genitourinary tract is a common extrapulmonary site of tuberculosis infection, yet remains a rare clinical entity in North America. We report the case of a 37-year-old man who presented for extracorporeal shock wave lithotripsy for a suspected ureteral stone on imaging. Further work up confirmed a diagnosis of genitourinary tuberculosis. Medical management was undertaken and ultimately, nephrectomy performed. This case highlights the importance of maintaining a high index of clinical suspicion for genitourinary tuberculosis.

Uterine Sarcoidosis: A Rare Extrapulmonary Site of Sarcoidosis

Sarcoidosis is a multisystem disease which is most commonly manifested in the pulmonary system. However, extrapulmonary manifestations have also been frequently reported. Isolated occurrence of sarcoidosis in the genital system is rare and poses a diagnostic and therapeutic dilemma. Uterine sarcoidosis can present with cervical erosions, endometrial polypoid lesions, and recurrent serometra. In majority of cases, it is diagnosed by endometrial curettage, but it has also been detected by examination of hysterectomy, polypectomy, and autopsy specimens. Nonnecrotizing granulomas are the characteristic pathologic finding of sarcoidosis. However, many infectious and noninfectious etiologies including certain neoplasms can produce similar granulomatous reactions in the female genital tract. These conditions affect the female genital tract more commonly than sarcoidosis, and therefore it is important to rule out these conditions first before making a diagnosis of sarcoidosis. Treatment of sarcoidosis is different from treating these other conditions and the most commonly used systemic or local corticosteroids can be hazardous if the underlying cause is infection. In this case report, the clinical presentation, histopathology, clinical course, and treatment of a patient with isolated uterine sarcoidosis are described, and a brief literature review of sarcoidosis of the female genital tract is provided.

A Rare Association of Inflammatory Myofibroblastic Tumor of Maxilla and Idiopathic Orbital Inflammatory Disease

ABSTRACT Inflammatory myofibroblastic tumor (pseudotumor) is a rare tumor belonging to the family of fibrous mesenchymal tumors. Though it usually involves lungs, but extrapulmonary site involvement, especially head and neck region is rare. In this paper, we are presenting a 26-year-old male patient, with inflammatory myofibroblastic tumor of maxilla, with a rare association with a prior history of idiopathic orbital inflammatory disease, treated medically. The patient was treated surgically with complete excision of the pathology from maxilla. This case report intents to review the controversies in management of this tumor and also to enlighten the possible association between the orbital and maxillary pseudotumor. How to cite this article Preetam C, Kumar R, Sikka K, Kumar R, Durgapal P. A Rare Association of Inflammatory Myofibroblastic Tumor of Maxilla and Idiopathic Orbital Inflammatory Disease. Clin Rhinol An Int J 2013;6(1):41-43.

Course and Prognosis of Sarcoidosis in a Referral Setting in Turkey; Analysis of 166 Patients

Backround: Clinical manifestations and prognosis of sarcoidosis are heterogenous and the prevalence varies depending on the country, area and race evaluated. Also the organs involved and courses of the disease differ greatly between countries, areas, races and individuals. Aims: To investigate the sociodemographic characteristics, clinical presentation and symptoms and to determine the severity and prognosis of sarcoidosis in Turkey as a referral center. Methods: Between January and July 2003 we retrospectively evaluated the outcome of the patients with sarcoidosis whose first clinical visits were between 1965 and 2003 in the multidisciplinary referral setting RS at Cerrahpasa Medical Faculty of the University of Istanbul. Data collected about each patient included sociodemographic characteristics, clinical presentation, symptoms, date of diagnosis, date and age of onset, method and stage of disease at the date of diagnosis and at the date of last evaluation; the mortality and survival rate were calculated. One hundred and sixty six consecutive patients whose first clinical visits were between 1965 and 2003 in the multidisciplinary RS at Cerrahpasa Medical Faculty were enrolled. We contacted every patient in our cohort by telephone calls or home visits. All those contacted were called back to outpatient clinic for a formal evaluation between June and September 2003. A formal physical examination and thorax radiography were performed in patients who came to the hospital. Their radiological stage, signs, symptoms and associated extrapulmonary manifestations were recorded. Results: At the initial presentation, the mean age of diagnosis was 40.3 years. The 31–40 age group is the group with the highest number of patients. Coughing was the most frequent symptom and erythema nodosum was the most frequent sign in both sexes. Thirty eight percent of patients had extrathoracic involvement. The most frequent extrapulmonary site of involvement was skin. The mortality rate was 11.6% (10.8% in females and 13% in males). Comorbidity was 3% (5 females, 1 male). Females, youngs and patients without extrathoracic involvement had higher survival rates. Conclusion: Clinical characteristics, course and prognosis of sarcoidosis vary in different studies. The results may vary accordingly to ethnic, geographic, social and economic conditions.

Nosocomial Transmission of Mycobacterium tuberculosis From an Extrapulmonary Site

Objective:To assess the extent of nosocomial transmission and risk factors associated with tuberculin skin test (TST) conversions among healthcare workers (HCWs) exposed to a patient with genitourinary Mycobacterium tuberculosis.Design:Retrospective cohort study of exposed HCWs.Setting:A 275-bed community hospital in Middle Tennessee.Participants:A total of 128 exposed HCWs and the index patient, who required drainage of a prostatic abscess and bilateral orchiectomy and expired after a 27-day hospitalization. Disseminated tuberculosis was diagnosed at autopsy.Methods:Contact tracing was performed on exposed HCWs. Logistic regression was used to identify independent risk factors associated with TST conversion.Results:A total of 128 HCWs were exposed to the index patient. There was no evidence of active pulmonary tuberculosis throughout the patient's hospitalization; TST conversions occurred only among HCWs who were exposed to the patient during or after his surgical procedures. A total of 12 (13%) of 95 exposed HCWs who were previously nonreactive had newly positive TST: 6 of 28 nurses, 3 of 3 autopsy personnel, 2 of 17 respiratory therapists, and 1 of 12 surgical staff. By logistic regression, irrigation or packing of the surgical site was the only independent risk factor associated with TST conversion among nurses (odds ratio, 9; 95% confidence interval, 1.2-67; P=.03).Conclusion:Manipulation of infected tissues of the genitourinary tract can result in nosocomial transmission of tuberculosis.

A 14-year-old boy with Isolated Tuberculous Orchitis

The genitourinary tract is the most common extrapulmonary site affected by tuberculosis. The male genital organs are involved in more than 50% of patients. The epididymis is the commonest structure to be involved, followed by the seminal vesicles, prostate, testis, and the vas deferens. An isolated tuberculous orchitis without epididymal involvement is rare. This case report describes extra pulmonary tuberculosis with exclusively testicular presentation. The confirmatory diagnosis of which was made by FNAC of the testis. It provides a successful diagnosis, thereby preventing unnecessary orchidectomy. Key words: genitourinary tuberculosis, testis, USG, FNAC doi:10.3126/jnps.v29i1.1598 J. Nepal Paediatr. Soc. Vol.29(1) p.30-32