A rare case of tuberculous polyserositis � A case report

Polyserositis is defined as chronic inflammation of several serous membranes with effusions in serous cavities like Pericardial, Pleural and Peritoneal membranes, resulting in fibrous thickening of the serous membranes and sometimes constrictive pericarditis. There are various causes of polyserositis which include autoimmune diseases, neoplasia, endocrine diseases, drug � related causes and infectious diseases such as tuberculosis. Polyserositis in disseminated TB is a very rare presentation. Diagnosis is often delayed due to the non-specific presentation like polyserositis and its unusual nature. We herewith report a rare case of TB polyserositis, involving pleura, pericardium and peritoneum.

Adult hemophagocytic lymphohistiocytosis triggered by disseminated tuberculosis and Klebsiella pneumoniaeco-infection in an immunocompetent individual-a diagnostic challenge

Here in we report a diagnostically challenging case of adult hemophagocytic lymphohistiocytosis (HLH) triggered by disseminated tuberculosis and Klebsiella pneumoniaeco-infection in an immunocompetent Individual. She was a young female presented with complaints of fever, abdominal pain and jaundice. Her evaluation showed cytopenias, hyperbilirubinemia, transaminitis, and hepatosplenomegaly. She progressed to have multi-organ involvement in the form of myocarditis, pleural effusion. Provisional diagnosis of fever with unknown origin and sepsis with multiple-organ dysfunction was made and evaluated for the same. Rapid clinical deterioration with evaluation for sepsis being normal prompted for considering HLH in the differential diagnoses, bone marrow and other criteria have been met resulting in confirmation of the same. Without prior past or family history of HLH, secondary HLH was suspected and substantial evaluation for possible triggers was made, and concomitantly immune suppression was started with corticosteroids. Disseminated tuberculosis was diagnosed and concomitantly Klebsiella pneumoniaewas isolated from the bronchioalveolar lavage cultures. As there was no significant immune response culmination, intravenous immunoglobulins were added along with the treatment for possible triggers-tuberculosis and Klebsiellasimultaneously. Patient showed significant improvement with this approach. In conclusion management of HLH is different from conventional sepsis and the treatment for each cause of HLH also varies. Furthermore, this case report stresses on the importance for initiating treatment rapidly and tailored approach of management therapy for each case.

A rare case of primary disseminated multi-drug resistant tuberculosis

Tuberculosis (TB) is the commonest cause of infection-related death globally. Disseminated tuberculosis (TB) is a life-threatening disease which results from the hematogenous spread ofMycobacterium tuberculosis. Genitourinary tuberculosis(GUTB) is usually caused as a result of the hematogenousspread of the mycobacteriaduring the initial infection. The patient's clinical presentation may vary from asymptomatic to non-specific symptoms related to the organ involved and may also overlap with urinary tract infections caused by other pathogens hence delaying the diagnosis. Here we report one such case where the vague symptoms of the patient and absence of respiratorysymptoms delayed the diagnosis of primary disseminated multi-drug resistant(MDR) tuberculosis.

Disseminated tuberculosis presenting as cardiac tamponade—Uncommon presentation in common disease

Tuberculosis is the most common infection in India, and its incidence accounts for approximately one-fifth of the global burden. Cardiac tamponade resulting from the liver abscess with subdiaphragmatic rupture communicating with pericardial cavity presenting as disseminated tuberculosis is uncommon. Here, we reported a case of a 63-year-old man who presented with the shortness of breath for 3 days with orthopnea. Imaging studies reveal pericardial effusion, left liver lobe loculated lesion, and enlarged right supraclavicular lymph node. Further image-guided pericardiocentesis, left liver lobe aspiration cytology, and right supraclavicular lymph node cytology reveal granulomatous inflammation with positive acid-fast bacillus in the liver aspirate. The patient was managed in the emergency room symptomatically initially and was then successfully treated with antituberculous treatment.

Tuberculosis pediátrica intestinal. Un caballo de Troya / Pediatric Intestinal Tuberculosis. A Trojan Horse

Resumen La tuberculosis (TB) intestinal y peritoneal es una enfermedad regional, crónica, específica, generalmente secundaria a TB pulmonar avanzada. Mayormente adopta la forma localizada en el tejido linfoide ileal. El diagnóstico puede sospecharse por los síntomas, los antecedentes del paciente y las pruebas de imagen, entre ellas radiografía de tórax, tomografía axial computarizada y ecografía. La confirmación precisa realizar una colonoscopia y toma de biopsia para demostración de granulomas caseificantes y del bacilo ácido-alcohol resistente. Presentamos un caso de un niño que consulto por absceso perianal y fístula, tratado como enfermedad intestinal inflamatoria y cuya radiografía de tórax motivó la sospecha y estudio de TB.

Abstract Intestinal and peritoneal tuberculosis (TB) is a regional, chronic, specific disease, generally secondary to advanced pulmonary TB. It is mostly localized at the ileal lymphoid tissue. The diagnosis may be suspected due to the symptoms, the patient's history, and imaging tests, such as chest x-ray, computerized axial tomography and echography. For confirmation, it is necessary to perform a colonoscopy and a biopsy sample to show caseating granulomas and the acid-alcohol resistant bacillus. We present the case of a child who consulted for a perianal abscess and fistula that were treated as inflammatory bowel disease, whose chest x-ray encouraged the suspicion and study of TB.

Levels of vitamin D in tuberculosis and comparison of vitamin D level in severe variant of tuberculosis like tubercular meningitis, miliary tuberculosis, disseminated tuberculosis with non severe variant of tuberculosis like pulmonary tuberculosis, tubercular lymphadenitis etc in paediatric age group

Background: Tuberculosis is deadliest disease killing nearly 2 million people every year. Before the etiologic cause of TB was determined by Koch, cod liver oil and sunlight, both sources of vitamin D, were used in treatment of tuberculosis. After discovery of antibiotics, anti-infectious value of vitamin D was ignored until increasing cost of antibiotics and rise in resistance led to the need to search for alternative and antibiotic-independent therapeutic strategies. This study shed light on vitamin D, which is very safe and inexpensive by adding vitamin D to antibiotic treatment, immune system can be boosted to help body to clear TB, rather than relying on antibiotics.Methods: A prospective, observational, comparative study in which 62 TB patients were taken and vitamin D level were estimated.Results: The results of study show that out of total 62 patients, 31 (50.00%) had deficient(<20ng/ml) vitaminD,23(37.10%) had insufficient(20-30ng/ml) vitamin D, 8(12.90%) had sufficient (>30ng/ml) vitamin D level. Out of 62 patients, 10(62.13%) had severe variety of TB and 52(83.87%) had' nonsevere TB. Among the 52 patients, 24(46.2%) had deficient vitamin D, 20(38.5%) had insufficient vitamin D and 8(15.4%) had sufficient vitamin D. Among the 10 patients with severe TB, 7(70.00%) had deficient vitamin D, 3(30.00%) had insufficient vitamin D and none had sufficient vitamin D level.Conclusions: Majority of children with tuberculosis demonstrated low serum levels of vitamin D (deficient and insufficient levels) suggest that vitamin D deficiency is' risk factor of tuberculosis and very low levels of vitamin D were noted in severe variant of TB then non severe suggest that in severe form of tuberculosis vitamin D levels were less compared to nonsevere variant.

Disseminated Tuberculosis Presenting as Gastric Outlet Obstruction

@#A 12-year-old female had a three-year history of fever, non-bilious vomiting and abdominal pain. Upper gastrointestinal series showed a filling defect at the duodenum. Esophagogastroduodenoscopy exhibited circumferential mass extending from the duodenal bulb to the 2nd part of the duodenum which on histology disclosed chronic granulomatous inflammation. Chest X-ray suggested miliary tuberculosis; endotracheal tube aspirate was PCR positive for Mycobacterium tuberculosis. Patient was diagnosed as disseminated tuberculosis of the duodenum and lungs. Quadruple anti-tuberculosis medication was started but patient succumbed to nosocomial sepsis.

Clinical characteristics of patients with positive blood culture for Mycobacterium tuberculosis in a general hospital / 中华传染病杂志

Objective To retrospectively analyze the clinical and laboratory characteristics of patients with positive blood culture results for Mycobacterium tuberculosis (M.tb).Methods The clinical laboratory database of patients suspected with disseminated tuberculosis from January 2009 to January 2017 in Huashan Hospital affiliated with Fudan University were collected and analyzed.The clinical manifestations,laboratory characteristics and outcomes between disseminated tuberculosis patients with positive blood culture (positive blood culture group) for M.tb and negative results (negative blood culture group) were compared.T test,Mann-Whitney U test and Fisher exact test were used for statistical analysis.Results A total of 5 589 patients suspected with M.tb infection had peripheral blood culture for mycobacterium.Positive blood culture for M.tb was found in 26 disseminated tuberculosis patients,while 6 patients finally identified as nontuberculous mycobacterium (NTM) with species identification,and 22 disseminated tuberculosis patients with negative blood culture results were enrolled during the same period as control.The mean age ([49.1 ± 10.1] years old vs [38.3 ± 17.1] years old,t =2.460,P =0.018),the proportion of diagnosed with fever of unknown origin at admission (FUO) (65.0％ [13/20] vs 13.6％ [3/22],P =0.001),the proportion of diagnosed with focal infection (30.0％ [6/20] vs 86.4％ [19/22],P =0.001),the proportion of patients with other diseases (75.0％[15/20] vs 22.7％ [5/22],P =0.002),the proportion of patients with hematological diseases (35.0％ [7/20] vs 4.5％ [1/22],P =0.018) and the proportion of patients with tumor (20％ [4/20] vs 0[0/22],P =0.043) in the positive blood culture group were significantly different from those in the negative blood culture group.Laboratory examinations of the percentage of neutrophils,the percentage of lymphocytes,the percentage of monocytes,the value of neutrophil/lymphocyte,the level of hemoglobin,the level of erythrocyte sedimentation rate,the level of C-reactive protein,the level of procalcitonin and the positive rate of T-SPOT.TB in positive blood culture groups were significantly different from those in negative blood culture group (all P ＜ 0.05).Conclusions Peripheral blood M.tb culture is more likely to be positive for those elder disseminated tuberculosis patients with hematological diseases or tumors,and those with increase of neutrophil counts and inflammation markers but reduction of lymphocyte counts and hemoglobin.

A 54-year-old male with diabetic nephropathy and suspected disseminated tuberculosis: Clinicopathologic correlation in a rare diagnosis

Tuberculosis (TB) and Non-Hodgkins lymphoma (NHL) share similar clinical and radiological features, which make diagnosis a challenge. It is often difficult to rule out a diagnosis of extrapulmonary and/or disseminated TB because of its paucibacillary nature and difficulty in accessing the involved organs. In countries with high prevalence of TB like ours, empirical antitubercular treatment (ATT) is started, and the patient is followed up closely for response. We present a rare case of a 54-year old diabetic male who was suspected to be a case of disseminated TB but had a rapid downhill course despite ATT. A postmortem revealed features of a rare, aggressive T-cell NHL masquerading as disseminated TB.

A contact investigation after exposure to a child with disseminated tuberculosis mimicking inflammatory bowel disease / 소아과

PURPOSE: Tuberculosis (TB) is one of the most important diseases that cause significant mortality and morbidity in young children. Data on TB transmission from an infected child are limited. Herein, we report a case of disseminated TB in a child and conducted a contact investigation among exposed individuals. METHODS: A 4-year-old child without Bacille Calmette-Guérin vaccination was diagnosed as having culture-proven disseminated TB. The child initially presented with symptoms of inflammatory bowel disease, and nosocomial and kindergarten exposures were reported. The exposed individuals to the index case were divided into 3 groups, namely household, nosocomial, or kindergarten contacts. Evaluation was performed following the Korean guidelines for TB. Kindergarten contacts were further divided into close or casual contacts. Chest radiography and tuberculin skin test or interferon-gamma-releasing assay were performed for the contacts. RESULTS: We examined 327 individuals (3 household, 10 nosocomial, and 314 kindergarten contacts), of whom 18 (5.5%), the brother of the index patient, and 17 kindergarten children were diagnosed as having latent TB infection (LTBI). LTBI diagnosis was more frequent in the children who had close kindergarten contact with the index case (17.1% vs. 4.4%, P=0.007). None of the cases had active TB. CONCLUSION: This is the first reported case of TB transmission among young children from a pediatric patient with disseminated TB in Korea. TB should be emphasized as a possible cause of chronic diarrhea and failure to thrive in children. A national TB control policy has been actively applied to identify Korean children with LTBI.

Síndrome de reconstitución inmune en un paciente de sida con una tuberculosis diseminada / Immune reconstitution syndrome in an AIDS patient with disseminated tuberculosis

La tuberculosis es un factor de riesgo en los pacientes con sida, ya que una vez iniciado el tratamiento antirretroviral pueden de desarrollar un síndrome de reconstitución inmune, lo que favorecería el deterioro del su estado clínico. Se presenta el caso de un paciente masculino, de 24 años de edad, diagnosticado de sida hace 4 años, y tratamiento irregular con antirretrovirales. Acudió al Hospital Universitario Clínico Quirúrgico "Comandante Faustino Pérez Hernández" con fiebre elevada, acompañado de cuadro general, manifestaciones respiratorias y dolor inguinal derecho. En el examen físico se constató un cuadro adénico generalizado, fue hospitalizado para estudio y tratamiento. Se diagnosticó un síndrome de reconstitución inmune en un paciente de sida con una tuberculosis diseminada, el cual fallece a pesar de la terapéutica impuesta. Este síndrome se caracteriza por una restauración gradual de la inmunidad patógeno-específica, donde el sistema inmune es capaz de reconocer patógenos presentes pero clínicamente ocultos. Se asocia a otros factores de riesgo y puede ser letal; de ahí que el reconocimiento oportuno de los pacientes con alto riesgo de contraerlo, así como un adecuado manejo sobre cuándo iniciar la terapia antirretroviral en cada caso específico, es quizá la única forma de prevenir su desarrollo (AU).

Tuberculosis is a risk factor in patients with AIDS, because once the retroviral treatment begins they can develop an immune reconstitution syndrome that would favor the deterioration of their clinical status. The case of a male patient, aged 24 years is presented. He was diagnosed with AIDS four years ago, and was irregularly treated with antiretroviral. The patient assisted the Clinic-surgical University Hospital "Comandante Faustino Pérez Hernández" with high fever accompanied by general characteristics, respiratory manifestations and right inguinal pain. At the physical examination, generalized adenic characteristics were found. A syndrome of immune reconstitution was diagnosed in an AIDS patient with disseminated tuberculosis; the patient died in spite of the imposed therapy. This syndrome is characterized by the gradual restoration of the pathogen-specific immunity, where the immune system is able of recognizing the pathogens that are present but clinically hidden. It is associated to other risk facts and may be lethal; therefore the timely recognition of the patients at high risk of suffering it, and also an adequate management about when to begin the anti-retroviral therapy in each specific case, is the unique way of preventing its development (AU).

Tuberculosis diseminada: Presentaciones inusuales en pediatría

Un 15 a 25% de los casos de tuberculosis presentan infecciones extrapulmonares. El diagnóstico temprano y tratamiento adecuado ayuda a reducir el riesgo de complicaciones y secuelas. La implementación del tratamiento estrictamente vigilado ha mejorado el control global de la tuberculosis, sin embargo es menos efectivo en las áreas donde prevalece la infección por VIH, la tuberculosis multidrogoresistente, la pobreza y donde la baciloscopia es la herramienta diagnóstica, la cual es excluyente en niños. La falta de un método sensible retarda el diagnóstico en la infancia, se realizan esfuerzos para el desarrollo de métodos simpli cados pero aún se carece de ellos. Se reportan 2 casos de tuberculosis diseminada en pacientes pediátricos, indígenas, Vih negativos, en dos grupos etarios extremos. Un lactante de 11 meses con tuberculosis miliar, cavitaciones pulmonares, efusión pleural y neumonía bacteriana complicada agregada y un adolescente de 13 años con meningitis tuberculosa e infartos isquémicos, neumonía con efusión y engrosamiento pleural. Ambos casos de interés por la relevancia epidemiológica de esta patología en la región y la variabilidad en la presentación clínica lo que impone mantener un alto índice de sospecha clínica en presencia de cualquiera de los criterios diagnósticos de tuberculosis.

A 15-25% of cases of tuberculosis have extrapulmonary infections. The early diagnosis and appropriate treatment helps to reduce the risk of complications and sequelae. The implementation of the strictly secure treatment has improved the global tuberculosis control, however it is less e ective in areas where the infection by HIV, TB multidrugoresistant, poverty prevails and where the sputum smear is the diagnostic tool, which is exclusive in children. The lack of a sensible approach delays the diagnosis in childhood, e orts for the development of simpli ed methods, but still are lacking them. Reported 2 cases of disseminated tuberculosis in patients paediatric, indigenous peoples, HIV-negative, in two extreme age groups. An infant of 11 months with miliary tuberculosis, pulmonary cavitations, pleural e usion and added complicated bacterial pneumonia and a teenager of 13 years with tuberculous meningitis and ischemic stroke, pneumonia with e usion and pleural thickening. Both cases of interest in the epidemiological relevance of this pathology in the region and the variability in clinical presentation which imposes maintain a high index of clinical suspicion in the presence of any of the diagnostic criteria of tuberculosis.

Tuberculosis sistémica en paciente inmunocompetente

Se presenta caso de mujer HIV negativa con tuberculosis diseminada con afectación cerebral, ósea y pulmonar. Durante su evolución desarrolló bacteriemia a Mycobacterium. Presentó buena evolución a tratamiento antituberculoso.

This is the case of an HIV negative woman with disseminated tuberculosis affecting her brain, bones and lungs.During the evolution, she developed bacteremia due to Mycobacterium. The patient had good evolution with anti-tuberculosis treatment.

Tuberculosis vulvar: Una rara localización / Vulvar Tuberculosis: A Rare Localization

La tuberculosis vulvar es una rara localización de la enfermedad, que debe incluirse en los diagnósticos diferenciales de lesiones ulcerosas o exofíticas dolorosas a ese nivel. Se presenta el caso de una mujer joven, VIH negativa, con grave compromiso del estado general debido a una tuberculosis diseminada con múltiples localizaciones: pulmonar, renal, genital, intestinal y peritoneal. La cepa de Mycobacterium tuberculosis aislada del esputo, orina y tracto genital fue pansensible y la paciente respondió al tratamiento con drogas de primera línea.

The vulvar tuberculosis is an uncommon localization of tuberculosis, which has to be included in the differential diagnosis of painful vulvar ulcerative or exophytic lesions. This report presents a case of an HIV negative young woman with severe compromise of her health status, due to disseminated tuberculosis with multiple localizations: pulmonary, renal, genital, intestinal and peritoneal manifestations. The strain of Mycobacterium tuberculosis isolated from sputum, urine and the genital tract was susceptible to all the antituberculosis medicaments and the patient responded to treatment with first-line drugs.

Chylous Ascites Due to Tuberculosis: A Case Report and Review of Literature.

Chylous ascites (CA) is an uncommon clinical condition and occurs as a result of disruption of abdominal lymphatics either due to trauma or secondary to obstruction. We report a case of CA associated with disseminated tuberculosis.

Disseminated Tuberculosis in a Patient with Chronic Renal Failure / 이화의대지

Patients with chronic renal failure (CRF) are known to be more susceptible to tuberculosis infection due to impairment of the host defense mechanism. Although extrapulmonary tuberculosis is more prevalent in those subjects and it may induce dismal outcome, its diagnosis has been challenging since there is no specific symptoms of the disease and the clinical course is usually atypical. Herein, We report a case of disseminated tuberculosis diagnosed by ultrasound-guided liver biopsy in a 31-year-old CRF patient presenting sustained fever despite broad-spectrum antimicrobial therapy and progressive cholestatic jaundice.

Primary disseminated extrapulmonary multidrug resistant tuberculosis.

Disseminated tuberculosis is a common mode of presentation of tuberculosis in patients both with and without HIV/AIDS in India. However, primary multidrug resistance in disseminated tuberculosis involving only the extrapulmonary sites in an immunocompetent adult is rare. Here, we report a case of a 19-year-old man who had disseminated tuberculosis involving left pleura, pericardium, peritoneum and intraabdominal lymph nodes. He was initially taking WHO category I antituberculous drugs, but was not responding in spite of 5 months of chemotherapy. Culture of the pleural biopsy specimen grew Mycobacterium tuberculosis which was resistant to isoniazid and rifampicin. He was put on therapy for multidrug resistant tuberculosis,following 24 months of chemotherapyhe had an uneventful recovery.

Disseminated tuberculosis and skull involvement in a non-immunocompromised child.

An unusual presentation of disseminated tuberculosis with lymphadenopathy, cutaneous lesions and skull bone involvement in a non-immunocompromised child.

Study on clinical characteristics, X quang imaging of disseminated tuberculosis

Study 66 patients (mean age 45.9 years) diagnosed disseminated pulmonary tuberculosis. Results: patients often were in sub-acute and chronic types (83.3%), and their symptoms begin slowly (81.8%). Suggestive symptoms are afternoon fever, autonomic nervous disorder, crepitant rales in both sides, and combined extrapulmonary tuberculosis. In radiographic imagines, there were expansive lesions (74.2%), usually in the upper lobes, although pleural adhesion (16.7%) and thin border nodules (9.1%) weren’t common but very specific. Common X-ray syndromes are nodule syndrome (100%) and alveolus syndrome (72.7%).

Henoch-Schonlein Purpura in a Disseminated Tuberculosis Patient / 대한소화기내시경학회지

Henoch-Schonlein purpura is a systemic leukoclastic vasculitis and involves small vessels resulting in vasculitis. Major pathogenetic mechanism of Henoch-Schonlein purpura has not been still elucidated. Possible causes, however, may be associated with viral infection, bacterial infection, exposure to drugs and toxins, systemic diseases and carcinomas. Henoch-Schonlein purpura rarely develops in patients with tuberculosis, though there have been some reports on the development of this syndrome during antituberculous therapy. A 24-year-old man was admitted to our hospital because of diffuse abdominal pain, lower leg purpura and disseminated tuberculosis involving lung, duodenum, colon and lumbar spine and diagnosed as Henoch-Schonlein purpura with disseminated tuberculosis. Henoch-Schonlein purpura developed before antibuberculous therapy and antituberculous treatment was effective both in disseminated tuberculosis and Henoch-Schonlein purpura. We concluded that disseminated tuberculosis might be a cause of Henoch-Schonlein purpura.