Tuberculous granuloma and cervical lymphadenopathy in an immunocompetent patient: a case report

Tuberculosis (TB) is one of the top 10 infectious diseases causing mortality worldwide. In 2019, approximately 10 million people were diagnosed with TB, with 5.6 million men, 3.2 million women, and 1.2 million children. One of the hallmarks of the course of TBis tuberculous granuloma. In this study, we reported a case of TB granuloma and further workup to exclude other etiologies. A 52-year-old man presented with a complaint of a lump on his left neck. There was a history of prolonged productive cough, weight loss, and shortness of breath. Chest radiograph and FNAB of the lump suggested pulmonary TB while the rapid molecular test was negative. The patient was also suspected of malignancy; but the trans-thoracal biopsy did not reveal any malignant cells. The patient was eventually diagnosed with granuloma due to primary TBwith cervical lymphadenopathy.Tuberculous granuloma is one of the most common pulmonary granulomasand a hallmark of the course of TB. It is characterized by the immune system forming an environment to control the spread of the infection. In cases of tuberculous granuloma with negative rapid molecular test, further investigations should be conducted to find evidence of TB infection. Activated TB granuloma can spread to the surrounding tissues or organs.A negative rapid molecular test result does not necessarily exclude TB in endemic regions; thus, further investigations such as CT scans or histopathological examination are required to find features of TB infection.

Advances in the role of macrophage polarization in tuberculosis / 中华临床感染病杂志

Tuberculosis is a kind of chronic infectious disease caused by Mycobacterium tuberculosis (MTB).Macrophages, as the main host cells against MTB ,play a crucial role in the natural and acquired immune response of the body.Under the stimulation of different inducing factors , macrophages can be polarized to M1-type macrophages and M2-type macrophages,which play different functions in the progression of tuberculosis.Further studies on the polarization signaling pathway of macrophages and dynamic balance between M1 and M2-type macrophages cells have provide a new way to explore the pathogenesis of tuberculosis.In addition, due to the importance of macrophage polarization in the development of MTB infection, the formation of tuberculous granuloma and prognosis of tuberculosis , the in-depth study on macrophages polarization will contribute to the development of new tuberculosis vaccines and immune agents , and lay an important theoretical foundation for the prevention and treatment of tuberculosis .

Relative value of immunohistochemistry in detection of mycobacterial antigen in suspected cases of tuberculosis in tissue sections.

Background: The diagnosis of tuberculosis (TB) depends on identifi cation of the infecting organism. The diagnosis presents as a challenge due to its diverse clinical presentation and low yield of acid-fast bacilli (AFB) in tissue sections. Aim: The aim of the present study is immunohistochemical localization of tubercle bacilli or their components that persist in the granulomas, but have lost the property of staining with acid-fast stain, assess the advantage of immunostaining over conventional Ziehl–Neelsen (ZN) staining and further to study the staining pattern on immunohistochemistry (IHC). Materials and Methods: The study population comprised 100 suspected cases of TB. Tissue sections from these were subjected to hematoxylin and eosin, ZN and IHC staining using polyclonal antibody to Mycobacterium tuberculosis followed by a comparative analysis of the results. Cases of lepromatous leprosy were used as a positive control. Results: Acid-fast bacilli were identifi ed by ZN stain in 23% of cases. IHC identifi ed 72% cases. In the present study, IHC had higher sensitivity (95.56%) and negative predictive value (96.43%), but lower specifi city (35.06%) and positive predictive value (30.56%) than ZN stain which had the sensitivity, specifi city, positive predictive value and negative predictive values of 30.56%, 96.43%, 95.65% and 41.56% respectively. Conclusion: Immunohistochemistry is a simple and sensitive technique for localization of tubercle bacilli and their components on tissue sections. It can be easily incorporated in routine histopathology laboratory and serve as an effi cient diagnostic adjunct to conventional ZN staining. This will help reduce the practice of prescribing empirical antitubercular treatment based on clinical suspicion alone.

A Case of Oculomotor Nerve Palsy and Choroidal Tuberculous Granuloma Associated with Tuberculous Meningoencephalitis

We report a rare case of oculomotor nerve palsy and choroidal tuberculous granuloma associated with tuberculous meningoencephalitis. A 15-year-old male visited our hospital for an acute drop of the left eyelid and diplopia. He has been on anti-tuberculous drugs (isoniazid, rifampin) for 1 year for his tuberculous encephalitis. A neurological examination revealed a conscious clear patient with isolated left oculomotor nerve palsy, which manifested as ptosis, and a fundus examination revealed choroidal tuberculoma. Other anti-tuberculous drugs (pyrazinamide, ethambutol) and a steroid (dexamethasone) were added. After 3 months on this medication, ptosis of the left upper eyelid improved and the choroidal tuberculoma decreasedin size, but a right homonymous visual field defect remained. When a patient with tuberculous meningitis presents with abrupt onset oculomotor nerve palsy, rapid re-diagnosis should be undertaken and proper treatment initiated, because the prognosis is critically dependent on the timing of adequate treatment.

A Case of Intradural, Extramedullary Tuberculous Granuloma Developed During the Treatment of Tuberculous Meningitis

A 24-year-old man was treated with anti-tuberculous therapy after being diagnosed with tuberculous meningitis. However, he developed abrupt onset of weakness in the lower extremities. Thoracic spinal magnetic resonance imaging (MRI) showed a soft tissue mass, a compressed posterior spinal cord. A total resection of the intradural extramedullary mass was performed. A histological examination revealed the infiltration of inflammatory cells with granulomatous lesions. Intradural extramedullary tuberculous granuloma is rare, but must be considered in the differential diagnosis of spinal cord compression.

A Case of Extradural Spinal Tuberculoma

Extraosseous extradural tuberculosis of the spine is rare entity. A 21-year-old man with low back pain, left-sided sciatica & motor weakness was admitted. Simple X-ray were normal. At operation, extradural, extraosseous granuation tissue were removed, which proved upon histologic examination to be tuberculous granulomas. The authors report a rare case of extraosseous tuberculoma in the posterior extradural space of whole lumbar region with review of literatures.