Scrofuloderma and tuberculous gumma in a young Filipino adult: A rare presentation of multifocal tuberculosis

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Cutaneous involvement is relatively uncommon representing a small fraction (1-2%) of the localizations of extrapulmonary tuberculosis. Cutaneous TB presents with several clinical forms, wherein one of the most common is scrofuloderma resulting from the direct extension of a tuberculous focus from a deeper structure such as the lymph node into the overlying skin. Tuberculous gumma is a rare form which occurs due to hematogenous spread of the TB bacilli. Although presenting with a wide clinical spectrum, it is believed that the association of different morphologies as well as numerous lesions and sites of cutaneous TB in a same patient is very rare.</p><p style="text-align: justify;"><strong>CASE REPORT:</strong> This is a case of a 20-year-old Filipino male presented with a fi ve-month history of several progressive cutaneous lesions initially presenting as subcutaneous nodules evolving into well-demarcated suppurative painless ulcers which were unresponsive to topical antibiotic. Skin punch biopsy from the medial malleolar area of the right foot revealed dilated blood vessels with a diffuse inflammatory infiltrate of lymphocytes, histiocytes, and few multinucleated giant cells. Clinical and laboratory findings were consistent with cutaneous tuberculosis. Patient was started on anti-Koch's treatment regimen and presented an excellent response to treatment showing resolution of the skin lesions on the neck and forearms and notable regression of the lesions on the right foot within four (4) months.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> This case serves as a reminder that cutaneous tuberculosis can manifest with a wide spectrum of clinical presentation which can mimic diverse dermatological conditions and may present with high rates of negative or equivocal diagnostic testing results. This report highlights the importance of a high index of suspicion in the timely diagnosis and management of tuberculosis in countries wherein tuberculosis remains a significant health burden such as the Philippines.</p><p style="text-align: justify;"><strong>KEYWORDS:</strong> Cutaneous tuberculosis, Scrofuloderma, Tuberculous gumma, Metastatic tuberculous abscess</p>

Primary Squamous Cell Carcinoma of Pleura Masquerading as Tuberculous Abscess: A Rare Case Report and Review of Literature

Primary pleural SCC is a rare pleural malignancy which has seldom been reported. Here we report a case of a 47 year male who presented with low grade fever, persistent chest pain and loss of appetite for 3 months along with a positive history of contact. CECT thorax demonstrated   fluid collection in the pleural space along with fibrotic patch and cytology revealed extensive necrosis. Based on above findings   provisional diagnosis of tuberculous abscess was made and subsequently anti- tuberculous treatment   was started. Later on after 3 months patient again presented with similar complaints and physical examination revealed a bulging mass on back which was aspirated and sent for cytology which revealed features consistent with the diagnosis of   poorly differentiated squamous cell carcinoma. This was later confirmed by CECT thorax, showing heterogeneous mass with pleural thickening and invasion. Histopathology eventually confirmed the diagnosis of primary pleural squamous cell carcinoma.

A Case of Metastatic Tuberculosis Abscess Associated with Miliary Tuberculosis / 대한피부과학회지

No abstract available.

MR Imaging of Anoperineal Tuberculous Abscess: A Case Report

Anoperineal tuberculosis is a rare extrapulmonary form of the disease and may present as abscess. We report a case of anoperineal tuberculous abscess, which showed low signal intensity on T1-weighted images, high signal intensity on T2-weighted images and diffusion restriction on diffusion weighted images.

The CT findings and clinical course of intraperitoneal tuberculous abscess / 대한내과학회지

Paradoxical response during antituberculosis treatment occurs frequently in non-HIV-infected patients as well as in HIV-infected patients, and intraperitoneal tuberculous abscess can develop as paradoxical response in tuberculous peritonitis patients rarely. The unique CT findings are not present and microbiologic or pathologic confirm is needed for diagnosis of intraperitoneal tuberculous abscess. Further study is needed to define steroid use or operation indication of intraperitoneal tuberculosis abscess.

An intraperitoneal tuberculous abscess: Computed tomography (CT) findings and clinical course / 대한내과학회지

BACKGROUND/AIMS: Intraperitoneal tuberculous abscesses develop infrequently. Because of overlapping features it is difficult to differentiate a tuberculous abscess from carcinomatosis peritonei. The aim of this study was to define the computed tomography (CT) findings and clinical course of the intraperitoneal tuberculous abscess. METHODS: The study included 11 patients (3 males, 8 females, mean age 34.8 years) with a pathologically proven intraperitoneal tuberculous abscess. We analyzed the CT findings and reviewed the medical records retrospectively. RESULTS: Sixteen abscesses were found in 11 patients. The locations of the abscesses were in the right subphrenic space (n=1), right perihepatic space (n=4), left perihepatic space (n=4), left subphrenic space (n=2), perisplenic space (n=3), right lower abdominal space (n=1), and left lower abdominal space (n=1). Five patients were proven to have abdominal tuberculosis while six patients had paradoxical responses to antituberculosis therapy for tuberculous peritonitis. The abscess lesions presented on the CT scan as thin walled cystic enhancing lesions without calcification (n=16), a septated mass (n=12), with enlargement of lymph nodes (n=2), and peritoneal and omental haziness (n=3). The mean duration from commencement of treatment to onset of a paradoxical response was 88 days. All patients had antituberculosis therapy for 6 to 12 months and five patients underwent surgery. The mean follow-up was 15 months. CONCLUSIONS: The intraperitoneal tuberculous abscess appeared as an ovoid cystic lesion with a slightly enhanced thin wall in the upper abdomen, in the perihepatic space on the CT scan; such as lesion can be the primary lesion of abdominal tuberculosis or associated with the paradoxical response of tuberculous peritonitis.

A Case of Hepatosplenic Tuberculous Abscess / 대한소아소화기영양학회지

Tuberculosis is not a common cause of liver abscess and it is rarely considered in the differential diagnosis of a patient with hepatic mass. We report a case of tuberculous abscess of liver and spleen in a 15-year-old boy who presented with abdominal pain, fever and weight loss. The ultrasonographic and computed tomographic scan of the abdomen revealed multiple cystic lesions in the liver and spleen. Mycobacterium tuberculosis was cultured from the ascitic fluid and biopsy specimen of lymph node. Follow up CT scan of the abdomen after anti-tuberculosis medication for eighteen months showed complete resolution of the cystic lesions with calcified nodules.

Hepatic Tuberculous Abscess and Miliary Tuberculosis in A Hemodialysis Patient / 대한신장학회잡지

The impairment of host defense mechanisms, particularly of cellular immunity, causes high incidence of mycobacterial infections in the patients with ESRD. Extrapulmonary mycobacterial infections are more frequent in ESRD patients compared to general population. However, there has been rarely reported on the occurrence of hepatic tuberculous abscess as an extrapulmonary mycobacterial infection in ESRD patients. We present a case of ESRD patient manifesting miliary tuberculosis and hepatic tuberculous abscess, which have successfully resolved after anti-tuberculous medications. A 44 years old male admitted with fever, general weakness, night sweating, and cough. Chest X-ray and abdominal CT revealed pulmonary miliary tuberculosis and a solitary tuberculous abscess at S7 of right hepatic lobe with multiple periportal and celiac lymphadenopathy. After the administration of anti-tuberculous medications(isoniazid, rifampicin, ethambutol - eight month, pyrazinamide - two month), miliary tubuculosis disappeared. The size of hepatic tuberculous abscess and lymphadenopathy were reduced in abdominal CT six month later. The patient is followed in outpatient without noticeable symptoms after eight month treatment.

Tuberculous Abscess of the Graft in a Renal Transplant Recipient after Chronic Rejection: Case Report / 대한이식학회지

Tuberculosis is a significant opportunistic infection often found in transplant recipients. Although not common, tuberculosis has been known to develop in higher incidence among transplant recipients than in the general population. The diagnosis and treatment of the tuberculosis in transplant recipients are more complicated because of the side effects of antituberculous agents, their interaction with immunosuppressive drugs, and the higher incidence of atypical presentations with extrapulmonary disease. The patient in this report had no evidence of tuberculous infection anywhere through the body before the transplant. The course of disease was continuously devastating despite active antituberculosis therapy. Only after the transplant nephrectomy, patient's general condition improved. The authors report a patient with tuberculous abscess, developed in a renal allograft after chronic rejection.

Tuberculous Abscess of the Graft in a Renal Transplant Recipient after Chronic Rejection / 대한이식학회지

Tuberculosis is a significant opportunistic infection in transplant recipients under the immunosuppressed condition, though not common and also known to have higher incidence among transplant recipients than in general population. The most common form of tuberculosis among transplant recipients is pulmonary, gastrointestinal, bone and genital tract in decreasing order. However tuberculous infection of the transplanted graft is rare and usually associated with disseminated tuberculosis with high mortality. We experienced M.. tuberculosis infection of the renal allograft after chronic rejection. A 28-year-old female received living-related renal transplantation, required high-dose steroid therapy for two episodes of acute rejection (8 and 20 months later). However, she eventually became renal failure due to chronic rejection and immunosuppression therapy was discontinued. Patient was refered back to our institute for the hemodialysis (post-transplant 40 months) when the patient was found to have pulomary tuberculosis of miliary type. Antituberculosis medication (INH, RFP, EMB & PZA) was immediately started on the basis of positive cultures from lung and bone marrow specimen for M. tuberculosis. In spite of full medication, high fever was sustained and subsequently pyonephritis of grafted kidney was detected and infected graft was removed to confirm the tuberculosis is very serious disease among immunosuppressed transplant patient and therefore more aggressive approach is needed including the search for the hidden infection even at the failed graft with cessated function

Tuberculous Brain Abscess: A Case Report

Tuberculous brain abscess is a rare form of the central nervous system tuberculosis. Clinical characteristics of the tuberculous brain abscess are symptoms and signs of intracranial hypertension rather than meningeal irritation. A 23-year-old man presented with headache and vomiting for 4 months. Neurological examination revealed mild left hemiparesis. Chest X-rays showed a large tuberculous cavity in the right upper lobe. Brain computed tomography scan revealed multiple ring enhancing cystic masses with marked edema and midline shift in the deep right temporo-occipital lobe. Without symptomatic relief with several months of antituberculous medication, the patient was subjected to stereotactic aspiration of the mass. Persistence of the abscess on postoperative CT scan rendered him to undergo right temporo-occipital craniotomy with removal of the remaining nodular mass. Follow up brain CT showed no residual abscess. He was discharged with no neurologic deficit. Having experienced this rare case with review on relevant literaturs, the authors suggest excision of the abscess cavity plays an important role to eradicate intracranial tuberculous abscess.

A Case of Metastatic Tuberculous Abscess of Skin Following Intestinal Tuberculosis / 대한피부과학회지

We reported herein a rare case of a 65-year-old female who lead intestinal tuberculosis of about 2 months duration, with little late development of metastatit berculosis abscess of the skin. The lesions were egg tow wolnut-sized abscesses or nodules occu in, on the back, right flank and lower abdomen with no pain or mild tenderness. Physical exami saion was unremarkable on dissemination of other sites. The tuberculin test was negative. The skin esions were diagnosed by clinical, histopathologic features, and positive results for Mycobactc iuntuberculosis in smear.; and cultures in the pus discharge: as well as polymerase chain reaction nethod on the nodular lesion. A barium enema showed the findings of intestinal tuberculosis, with positive culture in the stool. A combined treatment was intituted. During the initial 4 month, utaneous lesions did not respond and in some cases worsened with the multidrug of isoniazicr fampin, pyrazinamide and streptomycin, all of which were surgically excised. Thereafter, the drugs of isoniazid and rifampin were further administered for ahout 14 months, with the complete resecution of both lesions and the systemic symptomatolo. There was no relapse at follow-up after 6 months.

A Case of Tuberculous Abscess in Cerebrum

A case of Tuberculous abscess in cerebrum, in a 17 years-old male, is presented, which was confirmed Pathologically and microbiologically. At present, tuberculous infection progressively decrease, and especially occurs rarely tuberculous abscess in central nerve system. The prognosis is known to be poor. We have experienced a case of tuberculous abscess in cerebrum and obtained a good result after surgery. So, we report our case with a brief review of the articles.