Tuberculosis Lymphadenitis in a Well Managed Case of Sarcoidosis.

Differentiation between tuberculosis (TB) and sarcoidoisis is sometimes extremely difficult. Sequential occurrence of sarcoidosis and TB in the same patient is uncommon. We present the case of a young man, with a proven diagnosis of sarcoidosis who later developed TB after completion of treatment for sarcoidosis. A 32-year-old male patient presented with low-grade fever since two months. Physical examination revealed cervical lymphadenopathy. Initial fine needle aspiration cytology (FNAC) of the cervical lymph node was suggestive of granulomatous inflammation; the chest radiograph was normal. Repeat FNAC from the same lymph node was suggestive of reactive lymphoid hyperplasia. The patient was treated with antibiotics and followed-up. He again presented with persistence of fever and lymphadenopathy and blurring of vision. Ophthalmological examination revealed uveitis, possibly due to a granulomatous cause. His repeat Mantoux test again was non-reactive; serum angiotensin converting enzyme (ACE) levels were raised. This time an excision biopsy of the lymph node was done which revealed discrete, non-caseating, reticulin rich granulomatous inflammation suggestive of sarcoidosis. The patient was treated with oral prednisolone and imporved symptomatically. Subsequently, nearly nine months after completion of corticosteroid treatment, he presented with low-grade, intermittent fever and a lymph node enlargement in the right parotid region. FNAC from this lymph node showed caseating granulomatous inflammation and the stain for acid-fast bacilli was positive. He was treated with Category I DOTS under the Revised National Tuberculosis Control Programme and improved significantly. The present case highlights the need for further research into the aetiology of TB and sarcoidosis.

Endobronchial Non-Hodgkin’s Lymphoma presenting as mass lesion.

A 40-year-old male presented with clinical and radiological manifestations of right lung atelectasis and post-obstructive pneumonia. Flexible bronchoscopy revealed gross narrowing of the right upper lobe bronchus and a smooth, white endobronchial mass completely occluding the right lower lobe bronchus. Endobronchial biopsy from the mass lesion yielded low grade B-cell non-Hodgkin’s lymphoma. This is one of the rarest presentation of non-Hodgkin’s lymphoma.

Concurrent infection of pneumocystis pneumonia and pulmonary tuberculosis in an HIV-seronegative patient.

Co-infection with Pneumocystis jirovecii and Mycobacterium tuberculosis is rarely reported in patients without human immunodeficiency virus (HIV) infection. We describe the case of a 33-year-old HIV-negative female patient who was on long-term oral corticosteroids for rheumatoid arthritis and admitted with for respiratory distress and diffuse infiltrative pneumopathy in whom concurrent infection with Mycobacterium tuberculosis and Pneumocystis jiroveci was confirmed by bronchoalveolar lavage (BAL) fluid examination.

Subungual erythema in lymph node tuberculosis with erythema nodosum.

We encountered a case of tuberculous lymphadenitis with erythema nodosum presenting with an unusual manifestation as subungual erythema in all the digits. Relevant literature and the possible explanation for the subungual erythema have been discussed.

Tuberculosis of the parotid gland.

Tuberculosis of the parotid gland is a rare entity. Only about a hundred cases have been reported till date, mostly from parotidectomy specimens. The present case was diagnosed by fine needle aspiration and treated successfully by short-course antitubercular chemotherapy. An early diagnosis can avoid parotidectomy, which can be a hazardous procedure in a medically treatable condition.

Pneumomediastinum: a rare complication of brachial plexus block.

Pneumomediastinum, a rare complication of brachial plexus block in a young male is reported.

Acquired drug resistance in tuberculosis in Harayana, India.

Sputa of 200 treatment failure cases of pulmonary tuberculosis over a period of 1991-1995 were subjected to culture and sensitivity testing against commonly used anti-tuberculosis drugs. Out of 200 cases, 75% revealed resistance to one or more anti-TB drugs, resistance to isoniazid was observed in 72% cases, it was 49% for rifampicin, and 37% for streptomycin, while the resistance rate for other drugs was low. Majority of patients had resistance to two or three drugs concomitantly while resistance to 4, 5 and 6 drugs was of very low order and resistance to reserved drugs like kanamycin, ethionamide and cycloserine was encountered infrequently (1%). Out of 200 treatment failure patients multidrug resistance (MDR) was seen in 59% cases as 16% revealed resistance to isoniazid alone and strains in 22% cases were sensitive to all drugs. The study concludes that acquired MDR against first line antituberculosis drugs had increased as significant resistance against 3 drug combinations was observed although resistance against 2 drugs concomitantly was insignificant. Most ominous acquired drug resistance was seen against rifampicin in our region. The trends of drug resistance in the country and Haryana State are compared and their implications on outcome of chemotherapy are discussed.