Coinfección por lepra y tuberculosis ganglionar en un adulto / Leprosy and ganglionar tuberculosis coinfection in an adult

Se describe el caso clínico de un paciente de 34 años de edad, quien acudió a consulta de Dermatología por presentar máculas eritematosas pruriginosas generalizadas. A los 3 meses con tratamiento específico comenzó a presentar febrículas vespertinas y adenopatías cervicales dolorosas, por lo que se indicó una baciloscopia en ambos codos y pabellones auriculares, pero no se halló el Mycobacterium leprae; además se realizó biopsia por aspiración con aguja fina de un ganglio cervical, cuyo resultado reveló una tuberculosis ganglionar. Finalmente se diagnosticó una coinfección por lepra y tuberculosis ganglionar, dos enfermedades producidas por el Mycobacterium, cuya coexistencia es rara.

The case report of a 34 year-old patient is described who came to the Dermatology Service due to disseminated pruritic erythematous stains. After 3 months with specific treatment he began to present evening low fevers and painful cervical adenopathies, reason why a baciloscopy was indicated in both elbows and ear pavilions, but the Mycobacterium leprae was not found; besides aspiration biopsy with fine needle of a cervical ganglion was also carried out, which result revealed a ganglionar tuberculosis. Finally a leprosy and tuberculosis ganglionar coinfection was diagnosed, two diseases emerging due to the Mycobacterium, which coexistence is strange.

Reacciones paradójicas en el tratamiento de la tuberculosis ganglionar / Paradoxical reactions during tuberculosis lymphadenitis treatment

Lymphadenitis tuberculosis is the most frequent form of non pulmonary tuberculosis. Its incidence has increased in the last years probably because HIV co-infection. Usually manifests like a swelling of lymph nodes in the cervical region without constitutional symptoms. Diagnostics tests yields are poorer than in pulmonary tuberculosis probably due to the scarce bacillus population. Treatment is the same of pulmonary tuberculosis, but paradoxical reactions are far more frequent. These reactions, specially the latest presentations ones very often are treated as recurrence of the disease. Although this is always a possibility, in most cases they are due to an hypersensitivity reaction. In this article we present an illustrative case, an update on tuberculosis lymphadenitis and a review of the paradoxical reactions during its treatment.

La tuberculosis ganglionar es la forma más frecuente de tuberculosis extrapulmonar. Su incidencia ha aumentado, probablemente por la co-infección con VIH. Su presentación clínica más habitual es con un aumento de volumen de los ganglios cervicales sin síntomas constitucionales. Las pruebas diagnósticas tienen menos rendimiento que en la tuberculosis pulmonar por ser una enfermedad con menor población bacilar. Para el tratamiento se utilizan las mismas drogas y duración que en tuberculosis pulmonar, pero existe mayor incidencia de reacciones paradojales, las que pueden ser de difícil manejo. En este artículo presentamos primero un caso clínico particularmente ilustrativo, seguido de una puesta al día sobre tuberculosis ganglionar, incluyendo una revisión sobre el manejo de sus reacciones paradójicas.

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.

Tuberculosis ganglionar cervical: ¿Pensamos en ella, o nos sorprende? / Neck node tuberculosis: do we consider it... or does it pop up?

Revisamos las características clínicas, diagnóstico y manejo de la tuberculosis (TB) cervical, así como resaltamos su importancia por su carácter epidémico. Presentamos dos pacientes afectados por tumoraciones laterocervicales subagudas, escasa sintomatología y excelente evolución tras su diagnóstico de TB ganglionar cervical y tratamiento antibiótico. La TB es una enfermedad que en la actual sociedad globalizada, puede encontrarse prácticamente cualquier especialista, por lo que debemos mantener un alto nivel de alerta y conocerla con detalle, para poder orientar su diagnóstico y facilitar su tratamiento precoz.

We review tuberculosis clinical features, diagnosis and management as well as remark the importance of its epidemic nature. Study based on 2 patients suffering from eye-catching subacute neck lumps, sparsely symptomatic and excellent evolution after neck node TB diagnosis and antibiotic therapy TB represents a disease that, given our present time globalization, may be faced by many different specialists. That is why we must be on alert and be aware of its profile, in order to guess the right diagnosis and offer therapy.

Dental considerations in the management of children suffering from sickle cell disease: a case report.

Sickle cell disease (SCD) is a genetically derived disorder characterized by the presence of an abnormal hemoglobin molecule, designated as hemoglobin S (HbS). It is one of the most common genetic disorder worldwide, with an estimated 70 million people carrying the sickle gene. This article describes the dental considerations in managing a 6-year-old child suffering from SCD (SS type).

Drug provocation test in patient with antituberculosis drug allergy.

Hypersensitivity reaction is an unexpected drug adverse effect which sometimes can lead to fatal condition. Confirmation of the suspected drugs that cause hypersensitivity reaction is sometimes difficult. Drug provocation test is still a gold standard to establish the diagnosis of hypersensitivity to certain drugs or agents. Drug provocation test is a controlled drug treatment which aims at making diagnosis of hypersensitivity reaction to drugs. We reported a demonstration case of a 47 year-old female patient with hypersensitivity to anti tuberculosis drugs (isoniazid, rifampicin, pyrazinamid and ethambutol). Drug provocation test is important in this case to confirm which drug had caused hypersensitivity reaction because anti tuberculosis drugs were the treatment of choice for her illness.

Case report of lymph nodal, hepatic and splenic tuberculosis in an HIV-positive patient

We describe a case of a male patient, 38 years old, HIV-positive (most recent CD4 count about 259/mm³), with abdominal pain, nausea, vomiting, anorexia, weight loss, and vespertine high fever with chills. His hemogram showed normocytic and normochromic anemia, with a high erythrocyte sedimentation rate (ESR) and gross granulations in the neutrophils. Transaminases were normal. Bone marrow biopsy evidenced a chronic disease anemia pattern and a lack of infectious agents. Abdominal ultrasound examination showed a normal-size spleen, which exhibited heterogeneous parenchyma and multiple small hypoechoic images, together with small ascites, peripancreatic and para-aortic lymphadenopathy. These findings were confirmed by abdominal CT. The liver was normal in size, but had a hyperechoic image, which was not visualized on CT. Histopathological analysis of one of the multiple abdominal lymph nodes obtained by laparoscopic biopsy exhibited a chronic granulomatous inflammatory process, with caseous necrosis. Tissue sections were positive for BAAR (acid-alcohol-resistant bacillus), and the cultures were positive for Mycobacterium tuberculosis. Anti-tuberculosis treatment was begun, and the patient evolved with improvement of his general state, fever remission and weight gain. Splenic tuberculosis is a rare disease, occurring predominantly in patients in late stages of AIDS and/or disseminated tuberculosis. It is a difficult diagnosis, since there are no specific findings. Hence, complementary examinations, such as abdominal ultrasound/ CT, or fine needle aspiration, are usually necessary for investigation and differential diagnosis. Often, lesion regression after anti-tuberculosis regimens can be seen, and splenectomy is restricted to complicated or refractory disease.

Mycobacterium avium intracellularae complex associated extrapulmonary axillary lymphadenitis in a HIV-seropositive infant--a rare case report.

Opportunistic infections by Mycobacterium avium intracellulare complex in HIV infected patients, though common in adults, are rarely seen in infants. We herewith report an interesting case of an eight month old infant presenting with isolated axillary lymphadenitis, later on diagnosed to be tubercular lymphadenitis by Mycobacterium avium intracellulare and finally proved to be seropositive for HIV infection born to previously undetected HIV seropositive parents.

Tuberculous lymphadenopathy: an approach to diagnosis and management

The aim of the study is to determine the incidence of peripheral tuberculeus lymphadenopathy in western region of Saudi Arabia, its clinical presentation, the diagnosis and the assessment of the value of short-term chemotherapy.A prospective study of 64 consecutive patients with proven tuberclous lymphadenpathy were included in this study, using FNA and/ or lymph node excisional biopsy. Of the sixty-four patients included in the study, seventeen [26.6%] were males and 47 [73.4%] females. Their ages ranged from 18 to 96 years with a mean age of 40 years. The number of patients who presented with constitutional symptoms was 33 [51.6%].There was a preponderance of females; the female to male ratio was 2.7%, consistent with other studies. Matting and fixation of the nodes to the surrounding structures was present in 24 [37.5%] patients, while the nodes were discrete in the rest. Among which discharging sinuses and abscesses were noted in 10.9% and 7.8% of the cases respectively. Conclusions: The diagnostic yield of FNA can be augmented by performing two FNA attempts. One to be sent for cytopathological examination and the other for AFB smear examination and Mycobacterial culture. A short course of combined chemotherapy consisting of rifampicin [600 mg orally once daily], INH [10mg/kg daily] and pyrazinamide [15 mg/ kg] for 6 months and ethambutol [15mg/kg] for 2 months was an effective and satisfactory therapy in our patients, as proven by the lack of recurrence or relapse after 5 years of follows up

Frequency and effective treatment of ulcers and sinuses in cases of tuberculous cervical lymphadenitis

To investigate the frequency and effective treatment of ulcers and sinuses in cases of tuberculous cervical lymphadenitis [TCL]. Design: Observational cross-sectional study. Place and Duration of Study: Department of ENT, Head and Neck Surgery of Tribhuvan University Teaching Hospital [TUTH], Kathmandu, Nepal, during the period of two years from March, 2000 to February, 2002. Patients and A hundred cases of histopathologically confirmed cases of tuberculous cervical lymphadenitis of more than six weeks of duration were included in the study. Overall frequency of the complication as well as the efficacy of treatment regime was considered. Out of 100 patients, 8 [8%] were found to develop ulcers and/or sinuses during the process of development of TCL which were effectively treated [100% cure rate]. Mode of treatment was surgical excision of ulcers/sinuses along with affected underlying lymph nodes, followed by short course of anti-tubercular chemotherapy. Not a single case recurred during their follow-up period. In this series there was a low frequency of formation of ulcers/sinuses during the process of development of TCL. Surgical excision of ulcers/sinuses along with affected underlying lymph nodes, followed by short course of anti-tubercular chemotherapy is the effective methods of their treatment

Ethambutol and optic neuropathy.

PURPOSE: To demonstrate the association between ethambutol and optic neuropathy. METHOD: Thirteen patients who developed optic neuropathy after being treated with ethambutol for tuberculosis of the lung or lymph node at Siriraj Hospital between 1997 and 2001 were retrospectively reviewed. The clinical characteristics and initial and final visual acuity were analyzed to determine visual outcome. RESULTS: All patients had optic neuropathy between 1 to 6 months (mean = 2.9 months) after starting ethambutol therapy at a dosage ranging from 13 to 20 mg/kg/day (mean = 17 mg/kg/day). Seven (54%) of the 13 patients experienced visual recovery after stopping the drug. Of 6 patients with irreversible visual impairment, 4 patients had diabetes mellitus, glaucoma and a history of heavy smoking. CONCLUSION: Early recognition of optic neuropathy should be considered in patients with ethambutol therapy. A low dose and prompt discontinuation of the drug is recommended particularly in individuals with diabetes mellitus, glaucoma or who are heavy smokers.

Treating tuberculous lymphadenitis--ifs and buts.

Treatment of tuberculous (TB) lymphadenitis is virtually a specialist's job due to multiple aetiopathological factors. Diagnosis is difficult often requiring biopsy for several times. Treatment monitoring is more complex due to peculiar behaviour of TB lymph nodes. Situation has become worse due to sharp increase in the incidence of atypical mycobacteria. Due to profound improvement in antibiotic action, life-expectancy of immuno-compromised patients has also increased along with increased incidence of atypical mycobacteria in them. Clarithromycin, ethambutol, rifabutin and amikacin seem to act best on atypical mycobacteria-induced lymphadenitis. Along with rise of multi-drug resistance (MDR), drug-resistant TB lymphadenitis cases are also on the rise.

Ofloxacin induced arthropathy in patients with multi-drug resistance tuberculosis.

Some of the 4-fluroquinolones have been reported to induce arthropathy, but so far there are no case reports of arthropathy due to ofloxacin. Two cases of ofloxacin induced arthropathy in multi-drug resistance (MDR) tuberculosis are reported and possible drug interaction with other anti-tubercular drugs is discussed.

Aspects diagnostique et therapeutique de la tuberculose ganglionnaire: a propos de 42 cas

We report a retrospective study of 42 cases of lymphnode tuberculosis. We noted symptoms of tuberculosis impregnation in 92%, cervical localization in 71%, positive tuberculin intra- dermo-reaction in 77%, and accelerated erythrocyte sedimentation rate in 73% of the cases. Koch bacillus was detected in expectoration, urine or gastric liquid at the rate of 11% of the cases. Lymph node puction was suggestive in 4 out of 12 patients, showing giant cells with or without caseum. Lympth node biopsy, performed in 32 patients, was contributive in 94% of them. Another tuberculous localization was found in 14 cases mainly pulmonary [8 cases]

Tuberculosis cutánea e inmunodepresión / Cutaneous tuberculosis and immunodeficiency

Se presentan dos casos de tuberculosis cutánea en pacientes inmunodeprimidos. El primero es un paciente HIV+ y el segundo es una mujer inmunodeprimida por corticoterapia. Es muy importante realizar un diagnóstico temprano para implementar un tratamiento exitoso

Tuberculose ganglionar periférica / Peripheral ganglionic tuberculosis

A forma extrapulmonar da tuberculose é relativamente freqüente. No entanto o comprometimento axilar é incomum. Os autores apresentam um caso desta entidade e discutem os seus aspectos clínicos, epidemiológicos e terapêuticos, enfatizando a incidência e prevalência da tuberculose.