ABSTRACT
Nasopharyngeal and otitis media tuberculosis are rare extrapulmonary manifestations of Mycobacterium tuberculosis infection. We present a case of a middle-aged woman with manifestations of both conditions along with a description of the anatomical and temporal evolution of the disease. This case also highlights the difficulty of diagnosis and management of this condition, requiring a multidisciplinary approach. Extrapulmonary tuberculosis must be considered in the differential diagnosis of multiple head and neck conditions, including refractory chronic rhinosinusitis and otitis.
Subject(s)
Otitis Media , Tuberculosis , Diagnosis, Differential , Female , Humans , Middle Aged , Otitis Media/complications , Otitis Media/diagnosis , Otitis Media/drug therapy , Tuberculosis/diagnosisABSTRACT
Granulomatous pneumonitis is a rare complication of bacillus Calmette-Guerin immunotherapy following intravesical administration of bacillus Calmette-Guerin. The authors present an unusual case of a 67-year-old man who developed mild and non-specific symptoms, following intravesical bacillus Calmette-Guerin instillations. Examinations revealed features of miliary tuberculosis and granuloma suggestive of mycobacterial infection. Anti-tuberculosis treatment resulted in a remarkable improvement in his symptoms and gradually upgrading of radiological appearance. The symptoms were less severe than some others described but this case provides evidence that, even in some cases, specific treatment may be necessary. We highlight the importance of recognizing miliary Mycobacterium bovis as a probable complication of bacillus Calmette-Guerin immunotherapy. The clinical disease course can be mild, despite extensive bilateral miliary nodules on primary presentation.
A pneumonite granulomatosa é uma complicação rara da imunoterapia com bacillus Calmette-Guerin após administração intravesical de bacillus Calmette-Guerin. Os autores apresentam um caso incomum de um homem de 67 anos de idade que desenvolveu sintomas ligeiros e inespecíficos, após instilações de bacillus Calmette-Guerin intravesical. Os xames revelaram características da tuberculose miliar e granuloma sugestivo de infeção por micobactérias. O tratamento antibacilar resultou numa melhoria notável na sua sintomatologia e na melhoria progressiva das alterações radiológicas. Os sintomas foram de menor gravidade comparativamente a outros casos relatados na literatura, mas este caso fornece evidências de que, mesmo em algumas situações, um tratamento específico pode ser necessário. Destacamos a importância de reconhecer o Mycobacterium bovis disseminado como uma provável complicação da imunoterapia a bacillus Calmette-Guerin. O curso clínico da doença pode ser ligeiro, apesar da extensa disseminação miliar bilateral na apresentação primária.
Subject(s)
Adjuvants, Immunologic/adverse effects , BCG Vaccine/adverse effects , Granuloma/etiology , Pneumonia/etiology , Rare Diseases/etiology , Urinary Bladder Neoplasms/drug therapy , Adjuvants, Immunologic/administration & dosage , Administration, Intravesical , Aged , BCG Vaccine/administration & dosage , Granuloma/diagnostic imaging , Humans , Immunotherapy/adverse effects , Male , Pneumonia/diagnostic imaging , Rare Diseases/diagnostic imaging , Tomography, X-Ray Computed , Tuberculosis, Miliary/diagnosis , Tuberculosis, Miliary/etiologyABSTRACT
Tuberculosis of the chest wall constitutes 1% to 5% of all cases of musculoskeletal TB. Abscesses of the chest wall are rare tuberculous locations. Because of the resurgence of the tuberculosis associated to AIDS, that diagnosis must be considered more frequently. The authors present a case of osseous tuberculosis with an abscess rib in a patient with HIV. The combination of indolent onset of symptoms and compatible radiographic findings, strongly suggests the diagnosis. However, the confirmation with positive culture or histopathologic are essential for definitive diagnosis.
