Disseminated lymph node tuberculosis after splenectomy: an unusual case report in an adolescent

Background Splenectomized patients are at an increased risk for overwhelming post-splenectomy infections typically with encapsulated bacteria. The clinical association between splenectomy and lymph-node tuberculosis is unclear. Case presentation We describe a rare case of disseminated tuberculous lymphadenitis in an 18-year-old woman with history of splenectomy because of hereditary sherocytosis. She was admitted with enlargement of bilateral-cervical and left-axillary lymph nodes and fever. A diagnosis of probable tuberculosis was made based on the findings of fine-needle aspiration. Histology showed granulomas and extensive caseous necrosis, with the site of puncture located at an enlarged lymph node on the right side. The diagnosis was confirmed via nucleic-acid amplification tests following excisional biopsy of the left axillary lymph node. Disseminated tuberculous lymphadenitis was localized in the bilateral neck, right lung hilum, left sub-axillary region, and mediastinum, as detected from contrast-enhanced computed tomography of the neck. Conclusions Mycobacterium tuberculosis infection should be considered in children and adolescents with extensive enlargement of lymph nodes after splenectomy.

Study of extrapulmonary tuberculosis in tertiary care hospital children with reference to cartridge based nucleic acid amplification test

Background: Tuberculosis is an infectious disease cause by the mycobacterium tuberculosis which typically involve lung but can affect other site called extrapulmonary tuberculosis (EPTB). In EPTB lymph node tuberculosis is most common and most severe is tuberculous meningitis. Cartridge based nucleic acid amplification test (CBNAAT) have high sensitivity and perform both respiratory and non-respiratory specimen. The aim of this retrospective study is to find out the proportion of extra pulmonary tuberculosis in hospitalized patient and determine the association of CBNAAT in diagnosis EPTB and Rifampicin resistance.Methods: This is the retrospective observational study done at Civil Hospital Ahmedabad in between October 2017 to October 2019 among the admitted patient age 1 month to 12 year diagnosed cases of EPTB according to RNTCP guidelines. Data collection done by medical records as indoor case sheets and investigation data from laboratory department.Results: Incidence of EPTB among the hospitalized children is 1.95% and among total tuberculosis patient is 42.48%. Among 191 suspected EPTB cases 59 confirmed indicate sensitivity of 37.3% and no false positive cases indicate 100% positive predictive value. Sensitivity of CBNAAT was highest in gastric aspirate followed by CSF in present study.Conclusions: Tuberculosis is more common in male child less than 5-year-old with frequent risk factor is rural residential area, lower socioeconomic class and contact with active cases. In my study is CNS tuberculosis is most common. In my study mortality is higher among 1-to-5-year age group with co morbid condition are SAM and septicemia.

Chylous peritonitis in peritoneal dialysis

Chylous peritonitis (CP) is a rare complication in patients on peritoneal dialysis. There are many reasons for this. It can occur as a result of a traumatic insertion of the peritoneal dialysis catheter or secondary to infectious or drug causes. The evolution is favorable at the elimination of the causative agent. We report 3 cases of PC occurring in 3 patients on peritoneal dialysis. In 2 patients, CP was secondary to calcium channel blockers and in 1 case associated with lymph node tuberculosis. The cessation of the causative agent allowed a clarification of the effluent dialysate. CP is a mild form of non-infectious peritonitis that is often confused with infectious peritonitis. In this article we discuss the etiologies of CPs, the pathophysiology and the conduct to be held in front of a CP.

Nodal tuberculosis on positron emission tomography/computed tomography with 18F-Fluordexosiglucose, a case report

Tuberculosis is an infectious disease, caused by the Mycobacterium tuberculosis bacillus. Extrapulmonary disease can cause nonspecific symptoms and signs, which makes diagnostic suspicion difficult. We present the case of a man with a history of cancer in complete remission, diagnosed with lymph node tuberculosis, after being admitted to our hospital due to fever, dyspnea, and central chest pain. A Positron Emission Tomography / Computed Axial Tomography with 18F-fluordexosiglucose is requested; which showed multiple mediastinal adenopathic conglomerates with intense radiotracer uptake, suggesting ruling out malignancy. Active lymph node tuberculosis will show increased metabolic activity with Positron Emission Tomography / Computed Tomography with 18F-fluordexosiglucose, which could make the differential diagnosis with malignant tumors or other granulomatous diseases difficult, as in the case of our patient. Therefore, it is important to consider lymph node tuberculosis as a differential diagnosis in patients with adenopathies suspected of malignancy.

Bilateral optic neuritis as a first presentation of lymph node tuberculosis

Tuberculosis (TB) may affect the nervous system in many ways. We describe an immunocompetent teenage girl with lymph node TB who had first presented with bilateral optic neuritis. Detailed history identified features inconsistent with immune-mediated optic neuritis. Several unusual features prompted further investigation, including transient visual obscurations without raised intracranial pressure, prominent disc swelling and absence of laboratory findings to support an immune-mediated cause. Whole body PET/MR imaging identified widespread mediastinal and supraclavicular lymphadenopathy. Despite no known TB contacts, a negative interferon gamma release assay and a normal chest X-ray, a targeted lymph node biopsy confirmed TB.

Cervicofacial Herpes Zoster Complicating Ganglion-Pulmonary Tuberculosis: Case Report and Review of the Literature: A Case Report

Tuberculosis is an infectious disease; it has a variable degree of presentation, most often pulmonary while the extrapulmonary location is dominated by lymph node involvement, especially cervical. On the other hand, herpes zoster results from the reactivation of the virus that causes varicella. Here, we report the case of cervicofacial herpes zoster complicating ganglion-pulmonary tuberculosis in a 19-year-old female patient with a history of varicella during childhood, who presents bilateral lymphadenopathy, the diagnosis of pulmonary and lymph node tuberculosis is confirmed by histology, she has treated with anti-tuberculosis drugs and the evolution was marked by the presence of lymphadenopathy and the appearance of cervicofacial herpes zoster

Posterior reversible encephalopathy and status epilepticus in Takayasu arteritis

Takayasu arteritis (TA) is a rare, systemic, chronic inflammatory condition causing granulomatous vasculitis of medium-sized and large arteries of unknown etiology. A possible relationship between Takayasu arteritis and tuberculosis has been suggested but not proven until now. Posterior Reversible Encephalopathy Syndrome (PRES) and seizure are rare complications. We report a case of Takayasu arteritis with lymph node tuberculosis presented with status epilepticus and Posterior reversible encephalopathy syndrome.