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ABSTRACT Extrapulmonary tuberculosis associated with immune thrombocytopenia (ITP) is extremely rare. A likely association between ITP and pulmonary and lymph node tuberculosis was reported in a 29-year-old male patient. His platelet count decreased to 4,000/µL. Chest tomography revealed mediastinal adenomegaly, lymph node clusters in the aorta, and consolidation in the left upper lung lobe. Immunoglobulin and methylprednisolone were administered intravenously. The histopathology of the left upper lung lobe confirmed tuberculosis. The rifampicin/isoniazid/pyrazinamide/ethambutol regimen was initiated, and the corticosteroids were tapered off. This case suggests an association of tuberculosis with ITP, since the platelet count effectively normalized after tuberculosis treatment.
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Objective To analyze and compare the ultrasound elastography (UE) features of various types of cervical tuberculous lymphadenopathy (CTL), and to investigate the value and limitation of UE in diagnosis of CTL. Methods A total of 70 CTL patients confirmed by pathology or diagnostic treatment who were admitted to Shanghai Pulmonary Hospital affiliated to Tongji University from Jul. 2017 to Mar. 2018 were enrolled, and the images of conventional ultrasound and UE of the largest lymph nodes in each patient were retrospectively analyzed. According to the conventional ultrasound classification criteria of tuberculous lymphadenopathy, the lesions were divided into acute inflammatory type (type), caseous necrotic type (typeⅡ), cold abscess type (type III) and healing calcification type (type ). The elasticity score and strain ratio of various types of CTL lesions were summarized and compared. Results There were 24 (34.29%) typeCTL lesions, 28 (40.00%) typeⅡ, 12 (17.14%) type III, and 6 (8.57%) type . The hardness of CTL lesions of typeand typeⅡ was high, with the elastic score being 3-4 (47/52, 90.38%) and the strain ratio being 3-5; the hardness of type III was the lowest, with the elastic score being 1-2 (10/12, 83.33%) and the strain ratio2; the hardness of type was the highest, with the elastic score being 4-5 (6/6, 100.00%) and the strain ratio5. There were significant differences in elastic score and strain ratio among the four type CTL lesions (H＝30.756, F＝23.177; both P0.001). Pairwise comparison showed that except for the differences between typeand typeⅡ lesions, there were significant differences in elastic scores and strain ratios between the four type CTL lesions (P0.05). Conclusion The value of UE in the diagnosis of CTL is limited. It may play some roles in determining whether there is an obvious granuloma formation in typelesions and the tension of type III lesions.
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Objective To observe the short-term effect of Paris polyphylla Smith var. yunnanensis powder combined with anti-tuberculosis drugs in the observation of superficial lymph node tuberculosis. Methods A total of 170 patients were randomly divided into two groups: 80 in the control group and 90 in the observation group. The observation group consisted of nodular type, infiltrating type and abscess type, each of which had 30 cases. The control group were treated with Isoniazid, Rifampicin, Pyrazinamide and Ethambutol. Besides the four medications, the observation group were treated with external application of Paris polyphylla Smith var. yunnanensis. Results The response rate was 30.00％in the control group and 64.44％in the observation group. The response rate in the observation group was higher than that in the control group, with a statistically significant difference ( <0.01). In the observation group, the response rates of abscess, infiltration and nodule were 76.67％, 73.33％and 43.33％, respectively.By the comparative analysis, the response rate of infiltration was higher than that of nodule ( <0.05), with a significant difference; the response rate of abscess was also higher than that of nodule ( <0.05), with a significant difference. There was no significant difference between the response rates of abscess and infiltration ( >0.5) .Conclusions The external application of Paris polyphylla Smith var. yunnanensis powder combined with anti-tuberculosis drugs is curative in the observation of superficial lymph node tuberculosis, especially in the types ofinfiltrating and abscess.
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Objective To explore the clinical value of untrasonographically guided fine needle puncture ab -sorbing cytology examination in the diagnosis of cervical lymph node tuberculosis .Methods In March 2013 to June 2015 454 cases of suspected cervical lymph node tuberculosis cases were selected , and 454 suspected cases according to the voluntary principle were divided into two groups : US -FNAC groups: 326 cases with US -FNAC detection;FNAC groups: 128 cases, using FNAC.Statistical degree of two groups of detection sensitivity , specific, positive predictive value, negative predictive value and accuracy , and follow -up of two groups of complications .Results In US -FNAC group 326 cases, after the US -FNAC tested positie 308 cases, 304 cases confirmed by pathology after true positive and false positive 4 cases, through US -FNAC tested negatie 18 cases, were confirmed by pathology af -ter true negative, 15 cases of false negative in 3 cases; FNAC in the group of 128 cases of FNAC tested positie 107 cases, 102 cases confirmed by pathology after true positive and false positive in 5 cases, by FNAC tested negatie 21 cases, 12 cases confirmed by pathology after really negative , 9 cases of false negative.US -FNAC, the sensitivity of the detection of cervical lymph node tuberculosis (99.02%) than FNAC (91.89%), the difference was statisti-cally significant (p 0.05); US -FNAC, the accuracy of the detection of cervical lymph node tuberculosis (95.30%) than FNAC (89.47%), the difference was statistically significant (p <0.05); US - FNAC, incidence of complications (1.23%) is lower than the FNAC group (4.69%), and the difference was statistically significant (chi -square =5.1095, p =5.1095,p <0.05). Conclusion US -FNAC is used for the diagnosis of cervical lymph node tuberculosis , and has the advantages of high sensitivity, high accuracy.So US -FNAC diagnosis in cervical lymph node tuberculosis suspected cases has the important clinical value.
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Objective To explore the ultrasound imaging characteristics of thyroid papillary carcinoma complicated cervical lymph node tuberculosis, and to elucidate the key points of ultrasound diagnosis and to distinguish with cervical lymph node metastasis of papillary thyroid carcinoma.Methods In total, 1 5 well-documented cases of papillary thyroid carcinoma diagnosed definitely were selected, and there were 6 cases of concomitant lymph node metastasis. The ultrasonography of lymph node enlargement was analyzed, and the differences of the ultrasonographic characteristics between lymph node tuberculosis and metastatic lymph node including the location, swelling, calcification, blood flow and regional nodal liquefaction. Results Thyroid papillary carcinoma complicated with cervical lymph node tuberculosis was often found in the areas of Ⅲ,Ⅳ and Ⅴ, especially in the area of Ⅴ. Variety of echo was mixed in tuberculous of lymph node, and the echo was inhomogenous. The tuberculosis of lymph node calcification was patchy inhomogeneous distribution.The echo in part of liquefaction of lymph node tuberculosis was cottony weak. The flow signal of tuberculous lymph appeared the surrounding or internal punctate distribution,and the soft tissue was echogenic and disorder around the lymph node tuberculosis. Conclusion When ultrasonography examination is performed in the patients with the thyroid papillary carcinoma complicated with cervical lymph node enlargement, the history should be considered to analyze the ultrasound characteristics to dignose by observing the lesions of the surrounding soft tissues.
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A nine-month old boy was initially admitted at the Acute Respiratory Infection Unit of Dhaka Hospital of icddr,b and soon after transferred to the Intensive Care Unit of the same hospital. The boy had problems of very severe pneumonia (confirmed by radiology), severe hypoxaemia, severe malnutrition, and Down’s syndrome. The patient was treated according to the hospital protocol for the management of pneumonia and malnutrition. During the hospital stay, hypoxaemia was persistent with very little improvement of pneumonia; a number of differentials, such as pneumocystis jirovecii pneumonia, lymph-node tuberculosis, were added to the problems. Subsequently, the patient’s hypoxaemia improved with the empirical use of antitubercular drugs. However, the patient again developed persistent hypoxaemia and, after unsuccessful treatment for a hospital-acquired pneumonia, the problems further expanded to include interstitial lung disease (ILD). This was confirmed by high-resolution computed tomography, and the patient was treated with prednisolone for 6 months, along with antitubercular drugs. He fully recovered from ILD, hypoxaemia, and pneumonia both clinically and radiologically. Therefore, severely-malnourished children having wet cough and pneumonia with persistent hypoxaemia should be assessed for the possible existence of interstitial lung disease. This may help provide a prompt and appropriate management to reduce morbidity and deaths in such patients.
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Background: Effectiveness of low level nitrogen laser therapy along with antitubercular treatment (ATT) in cases of treatment failure and drug resistant tubercular lymphadenopathy, sinuses and cold abscess. Methods: In a double-blind randomized controlled trial of LLLT ,104 patients assigned to either the low level nitrogen laser therapy along with ATT ( LLLT group) (n =54) or ATT only(Chemotherapy group)(n=50). Both groups were treated two times per week for five weeks. Those in the treatment group received pulse nitrogen laser with a pulse duration of seven nanosecond, wave length 337 nanometer and average power output of 5 mW whereas those in the control group were treated with sham laser. The primary outcome measure was bacteriological conversion and the secondary outcome measures were decrease in size of lesion and the clinical improvement. Results: Acid Fast Bacilli (AFB) smear, AFB culture and Polymerase Chain Reaction(PCR) conversion rate at five weeks (after 10 sittings of laser) were 49.15%( Fishers P exact test-p= 0.015), 60%, 44.44% (Fishers P exact test-p= 0.048 ) in LLLT group as compared to 11.86%,20%,17.77% in chemotherapy group. Average percentage reduction in the size of gland at 5 weeks was 70.67% (p value 0.01) as compared to 54.81 in chemotherapy group. Average time taken for closure of sinuses was 11.03 weeks in LLLT group as compared to 26 weeks in chemotherapy group. The follow up was conducted for two years. Conclusion: Low level nitrogen laser therapy can be used as an adjunctive therapy along with antitubercular drugs in cases not responding and drug resistant tubercular lymphadenopathy, sinuses and cold abscess.
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Objective To discusses the clinical efficacy of regional lymph node dissection for neck lymph node tuberculosis. Methods One hundred and four cases with neck lymph node tuberculosis were enrolled in the study,which were admitted from December 2004 to December 2007 in our hospital. Among all cases there were tubercle(25 cases),infiltration(29 cases),abscess(32 cases)and ulcer(18 cases). All patients underwent regional lymph node dissection and postoperative standardized anti-TB drugs treatment. Results One hundred and four cases were all cured(cure rate 100%). Incision healed of class A in 100 cases,while healed of class B in another 4 patients,who took anti-TB drugs treatment for 2 weeks and achieved curation later. All patients were followed up for 2 years,and we found recurrence in 3 cases(recurrence rate 2.88%). Conclusions The regional lymph node dissection treatment for neck lymph node tuberculosis,followed by standardization body line anti-TB drugs,is feasible therapy. The treatment is safe,quick,curative,with low recurrence rate,and the surgical incision is beautiful.
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A 25 year-old, HIV seronegative male presented with bilateral cervical lymphadenopathy with cold abscesses and sinus formation, peripancreatic lymphadenopathy and hypodense lesions in the spleen. Culture of pus aspirated from the cold abscess in the neck grew M.tuberculosis resistant to Rifampicin, Isoniazid, Ciprofloxacin and Para-aminosalicylic acid. In a resource-limited setting, he was treated with Ethambutol (E), Pyrazinamide (Z), Ethionamide (Eth), Cycloserine (Cyc), and Ofloxacin (Ofl). While on treatment, he developed drug induced hepatotoxicity; Z and Eth were stopped and clofazimine was added to the regimen. Subsequently, he developed splenic abscess and clofazimine induced generalized pigmentation of the body including tongue. After eighteen months of treatment, lymphadenopathy and splenic lesions regressed significantly. Thus, present case highlights several important basic principles of management of MDR-TB such as procuring tissue for microbiological testing, judicious use of imaging modalities, careful monitoring for adverse drug reactions, intercurrent infections and the need for pretreatment counselling for ensuring compliance and completion of treatment.