Efficacy and safety of intrapleural streptokinase in tubercular empyema thoracis – old wine in new wineskin

Tubercular empyema thoracis continues to be one of the leading causes of morbidity in low-income countries. Despite antitubercular therapy (ATT) and thoracostomy, empyema drainage is hampered by multiple septations, loculations, debris, and blood clots leading to complications. In a comparative experimental study to estimate the efficacy and safety of intrapleural streptokinase (IPSTK) in tubercular empyema, 30 cases of chronic multiloculated tubercular empyema were compared by radiological improvement by chest radiography, duration and volume of fluid drained, and degree of dyspnoea according to the modified Borg scale, depending on whether streptokinase was used or not. The former scored on all counts; we therefore conclude that intrapleural streptokinase is a safe, efficacious intervention in tubercular empyema. It decreases morbidity and reduces the need for surgery.

1403. Tuberculous sacroiliitis: Clinical and Imaging Characteristics

Background Osteoarticular tuberculosis remains a common disease among which the spine is the most affected site. Less frequently, sacroiliac joint is involved. Its diagnosis is often delayed due to misleading and varied symptoms. The aim of this work was to study the clinical features and the contribution of imaging results in the diagnosis of tuberculous sacroiliitis. Methods We conducted a retrospective study including all patients hospitalized in the infectious disease department for tuberculous sacroiliitis. The diagnosis was based on clinical, laboratory and radiological features. Results In total, we encountered 12 women with a median age of 51 [39-63] years. Three patients had a family history of tuberculosis (25%). The median diagnostic delay was 155 [48-331] days. The revealing symptoms were lower back pain (75%) and hip pain (25%) associated with fever (83.3%) and weight loss (75%). Reduced mobility was noted in 3 cases (25%). Pulmonary tuberculosis and tuberculous spondylodiscitis were associated with tuberculous sacroiliitis in 5 cases (41.7%) and 4 cases (33.3%), respectively. Tuberculin skin test was positive in 6 cases (50%). Laboratory investigations revealed elevated C-reactive protein levels in 11 cases (91.6%) and accelerated erythrocyte sedimentation rates in 9 cases (75%). Needle biopsy of the sacroiliac joint (41.7%) and soft tissues abscess puncture (16.6%) were performed. Computed tomography scan revealed joint space widening (83.3%), peripheral joint erosions (83.3%) and osteolysis (58.3%). Soft tissue abscesses were noted in 66.7% of the cases. Magnetic resonance imaging was performed in 4 cases (33.3%). Sacroiliac joint was hypointense in T1-weighted images (75%), hyperintense in T2 weighted images (50%) and in STIR images (50%). Bone scintigraphy, performed in 5 cases, revealed hyperfixation of the sacroiliac area (100%). All patients received antitubercular therapy. Percutaneous abscess drainage was indicated in 4 cases (33.3%). Conclusion Because of its deep localization, the diagnosis of tuberculous sacroiliitis is mainly based on imaging results associated with epidemiological, clinical and laboratory features. Antitubercular therapy initiated promptly leads to recovery. Disclosures All Authors: No reported disclosures

246. Particularities of Non-axial Osteoarticular Tuberculosis Among Adults

Background Osteoarticular tuberculosis (TB) represents 1% to 3% of all TB cases, among which spondylodiscitis is the most common presentation of the disease. Non-axial TB is less frequent. We aimed to study the clinical, therapeutic and evolutionary features of non-axial osteoarticular TB. Methods We conducted a retrospective study including all patients hospitalized in the infectious diseases department for non-axial osteoarticular TB between 1999 and 2019. Results We encountered 51 cases, among which 26 cases were males (51%). The mean age was 41±20years. Ten patients were previously treated for TB (19.6%). The revealing symptoms were fever (70.5%), asthenia (68.6%), weight loss (60.7%) and night sweets (43.1%). Arthritis was noted in 20 cases (39.2%) represented by TB of the hip (10 cases), knee (4 cases), shoulder (4 cases) and elbow (2 cases). There were 12 cases of sacroiliac osteoarthritis (23.5%) and 6 cases of femur osteomyelitis (11.7%). Other affected sites included sternum (7.8%), toe (5.9%), tibia (5.9%), mandible (2%), clavicle (2%) and mastoid bone (2%). Multifocal TB was noted in 12 cases (23.5%). Pulmonary TB was associated to osteoarticular TB in 13.7% of cases. The mean duration of antitubercular therapy was 10±5months. Fixed dose combinations were prescribed in 17.6% of the cases. The disease evolution was favorable in 47 cases (92.1%). Relapse was noted in 3 cases (5.8%) and death in one case (2%). Conclusion Non-axial osteoarticular TB was not a rare disease. Multiple sites might be involved which facilitate the diagnosis confirmation. Prolonged antitubercular therapy might be required. Disclosures All Authors: No reported disclosures

1398. Gland Tuberculosis: A Rare Localization of Tuberculosis

Background Tuberculosis (TB) is a multisystem disease that might affect all organs. Gland TB is characterized with a misleading clinical presentation which often mimic a neoplastic process. The aim of our work was to study the clinical, therapeutic and evolutionary features of gland TB. Methods We conducted a retrospective study including all patients hospitalized for gland TB in the infectious disease department between 1999 and 2020. Results We encountered 28 cases among which 24 were females (85.7%). The mean age was 39±14 years. A rural origin was noted in 15 cases (53.5%). Two patients were previously treated for TB (7.1%). Systemic symptoms of TB included fever (60.7%), asthenia (53.5%), loss of appetite (46.4%) and weight loss (25%). There were 18 cases of breast TB (64.3%), 4 cases of salivary gland TB (14.3%) and 3 cases of ovarian TB (10.7%). Two cases of pituitary TB (7.1%) and one case of adrenal TB (3.6%) were noted. Multifocal TB was noted in 7 cases (25%). Lymph node (17.8%), pulmonary (14.2%) and peritoneal (7.1%) TB were associated with gland TB. Tuberculin skin test was positive in 19 cases (67.8%). The diagnosis was based on histopathological proof in 23 cases (82.1%), microbiological proof in 4 cases (14.3%) and clinically confirmed in one case (3.6%). The median duration of antitubercular therapy was 10 [9-15] months. Patients received fixed-dose combination in 11 cases (39.2%). Adverse effects of antitubercular therapy were noted in 10 cases (35.7%) represented by gastrointestinal symptoms (14.3%), increase in hepatic enzyme levels (14.3%) and skin reactions (7.1%). The disease evolution was favorable in 26 cases (92.9%). Relapse was noted in two cases (7.1%). Conclusion Gland TB included different sites. The presence of systemic symptoms of TB and the diagnosis of TB elsewhere in the body helped through the diagnosis process which requires high index of suspicion. It was mainly based on histological evidence. Disclosures All Authors: No reported disclosures

Distinct recurrence pattern in a case of bilateral tubercular posterior uveitis: reporting a unique clinical morphology and management challenge

Intraocular tuberculosis has protean clinical manifestations and remains an important etiological differential for uveitis in an endemic region. A 27-year-old male presented with visual acuity of counting fingers close to face in right (OD) and 20/25 in left eye (OS). Examination revealed a choroidal granuloma in OS and healed serpiginous-like choroiditis in OD. Antitubercular therapy was started with systemic corticosteroids. Granuloma resolved completely; however, the patient presented with neuroretinitis and posterior scleritis, as first and second recurrence, respectively, within a oneyear period. These were managed with systemic corticosteroids and immunosuppressive therapy was added, after second recurrence. The patient responded well and maintains remission. This case presented a clinical challenge with distinct recurrence patterns of tubercular posterior uveitis in the same eye, which has not been reported before. Successful management entailed use of antitubercular therapy, corticosteroids, and immunosuppressive therapy in a step-ladder approach, resulting in preservation of vision and achieving long-term remission.

Isoniazid induced palmoplantar hyperhidrosis

Secondary focal hyperhidrosis is usually due to peripheral or central neuronal defects and is a complex dysfunction of the parasympathetic and sympathetic nervous system. Palmoplantar hyperhidrosis has been described with various types of polyneuropathies such as diabetic but has not previously been described with isoniazid. We report a 15-year-old boy, being followed for neurotuberculosis, who presented with burning sensation and hyperhidrosis of both palms and soles five months after starting antitubercular therapy. With oral pyridoxine supplementation, the paraesthesia and hyperhidrosis reduced to minimal severity over the next four months. Before commencing antiperspirants, simple pyridoxine supplementation can lead to the reversal of symptoms in such cases.