Sarcoidosis mimics lepromatous leprosy: a case report.

A 34-year-old Thai man presented with a two years history of progressively enlarged lepromatous leprosy like nodules and plaques on his back, chest, and scalp. Skin biopsy showed diffuse nonnecrotizing granulomatous inflammation with numerous multinucleated giant cells, lymphocytes, and plasma cells infiltration. The missed diagnosis of leprosy was made and was treated with antilepromatous drugs for one year. After repeated skin biopsy, the diagnosis was compatible with sarcoidosis. He was treated with prednisolone 40 mg per day for two weeks. The lesions gradually decreased in size and were controlled with prednisolone 10 mg per day.

Medical characteristics and tuberculosis treatment outcomes in an urban tertiary hospital, Thailand.

The purpose of this study was to describe medical characteristics and assess treatment outcomes at a respiratory clinic, tertiary hospital, Bangkok, Thailand. One hundred seventy-seven patients diagnosed as having any type of TB and having taken anti-TB drugs for one month were included in the study. The patients were interviewed the end of the first month and their medical files were reviewed at the end of treatment to obtained the treatment outcome. Descriptive statistics and chi-square test were used in the data analyses. Of the total of 177 patients, 33.3% were new smear-positive, 19.2% were new smear-negative, 18.1% were extra-pulmonary TB, and 29.4% were other. The prevalence of TB/HIV co-infection was 33% (18 of 54). Resistance to at least one anti-TB drug was 31.6% (6 of 19). Due to high treatment default rates, treatment completion rates were low, 64.4% in new smear-positives, 61.8% in new smear-negatives, 71.9% in extra-pulmonary TB, and 46.2% in other. Treatment default rates significantly differed among the four types of TB (chi2 = 8.3, p = .04). The findings indicate a high proportion of extra-pulmonary TB, high prevalence of TB/HIV coinfection, and low treatment completion in urban TB patients at the tertiary hospital. Interventions are needed to integrate the strengths of the tertiary hospital regarding the availability of chest specialists and advance diagnostic tools into the other levels of health service to improve treatment outcomes in urban populations.

Respiratory complication of tsunami victims in Phuket and Phang-Nga.

In the present report the authors describe the clinical and laboratory findings of 26 tsunami victims admitted to the Phuket and the Takua Pa Hospital. Patients were classified into 4 groups of severity. class 1, baseline examination negative (n = 1); class 2, baseline examination positive but mechanical ventilation not needed on admission (n = 15); class 3, mechanical ventilation required on admission (n = 9); class 4, cardiopulmonary arrest (n = 1). On admission, 21/23 patients had fever of > 37.5 C. 3/10 patients had hypernatremia and 7/10 cases had metabolic acidosis. The radiological manifestation varied from focal disease to diffuse infiltrations, either reticulonodular or patchy lesions. There were 3 clinical courses among diffuse diseases: 1) diffuse infiltrations and progression 3 cases 2) diffuse infiltration, early regression followed by progression 2 cases 3) diffuse infiltration and steady regression 5 cases. Late complications comprised of pneumothorax/pneumomediastinum (n = 5) and bacterial pneumonia (n = 18). The authors got culture data in 9 patients, most of them were infected with aerobic gram -ve bacteria and 2 of them were B. pseudomallei. The prognosis in the tsunami related medical illness was favorable. Only 2 patients (7.7%) died in the present study.