Cold Abscess of Bilateral Parotids: Delusion or Reality?

Tuberculosis being endemic in country like India can affect any organ though pulmonary tuberculosis is rampant and extrapulmonary is rare. Tuberculosis affecting parotid gland is a rare occurrence, usually unilateral. However, Mycobacterium tuberculosis causing cold abscess in bilateral parotid glands is even rarer. Here, we present a case of a young female presented with bilateral slow-growing swelling in the parotid region with evening raise of temperature for two months. On clinical examination, no signs of inflammation were seen. Ultrasonography showed thick-walled hypoechoic collection with septae and internal echoes within involving both superficial and deep lobes of the parotid gland. Fine-needle aspiration cytology (FNAC) suggested a caseating granuloma and acid fast bacilli were detected on ZN staining, thereby confirming the diagnosis of cold abscess. She was put on antitubercular drugs and there was a drastic reduction in the size of swelling.

Cervical tuberculosis treated with closed system abscess evacuation, and percutaneous laser disc decompression combined with secretome derived from umbilical cord mesenchymal stem cells: A case report.

INTRODUCTION AND IMPORTANCE: Minimal invasive surgery is preferred as it offers the same benefit with less tissue damage, especially in the cervical area where a lot of critical structure resides. Mesenchymal stem cells (MSCs) and its secretome provide a promising regenerative intervention to damaged tissue. We report a cervical spinal tuberculosis case with hemiparesis treated with minimally invasive surgery combined with a regenerative approach. CASE PRESENTATION: A 13-year-old boy presented with weakness in his left arm and left leg, accompanied by hemiparesthesia. The patient was unable to get up from bed, run, and jumpRadiology examination showed compression fracture, intervertebral disc retropulsion, spinal cord compression, and paravertebral cold abscess. The patient was treated with a single minimal invasive surgery consisting of closed system abscess evacuation, and percutaneous laser disc decompression combined with umbilical cord-derived mesenchymal stem cells. CLINICAL DISCUSSION: The pain, weakness, and numbness were gone two days after surgery. The patient could carry out normal activities, even doing sports such as mini soccer and badminton. This clinical improvement was obtained as he carried out some procedures. The cold abscess aspiration removed infection focus which prevents further vertebra destruction, PLDD which decompresses the retropulsed discs, and implantation of MSCs and secretomes which regenerate and strengthen the destructed bone and surrounding tissue. CONCLUSION: Closed system abscess evacuation, and percutaneous laser disc degeneration combined with secretome derived from UC-MSC are minimally-invasive strategies with promising results. Further studies are required to investigate its efficacy.

Thyroid tuberculosis and cold abscess after infection with COVID-19: A case report.

There is mounting evidence that coronavirus disease 2019 (COVID-19) can cause immune dysregulation. The consequence of this immune dysregulation may contribute to susceptibility to tuberculosis (TB). Thyroid gland involvement by TB is extremely uncommon and typically the result of disseminated infection. It can be hard to diagnose because there are no identifiable symptoms. We present the case of a Chinese patient who had a fever again after COVID-19 infection that was finally diagnosed as thyroid tuberculosis with a cold abscess. Clinicians should maintain a high index of suspicion for high-risk patients from endemic regions with medical comorbidities, such as immunocompromised disease and malnutrition.

Radiological Evaluation of a Rare Case of Rib Caries and Cold Abscess in a Young Male Patient With Miliary Tuberculosis: A Case Report With Review of Literature.

Rib caries with a cold abscess is a rare presentation of tuberculosis (TB) and is tricky to diagnose. It is rarer in young patients, especially in conjunction with active miliary TB. We present one such case of a 23-year-old male patient who presented with swelling over the left lower chest. Rib caries and cold abscess were initially detected by ultrasonography and elastography. The rib involvement and the extent of the cold abscess were further evaluated on a computed tomography scan, which also showed active pulmonary miliary TB. The patient was treated by aspiration of the cold abscess and anti-tuberculosis therapy. The fact that the patient had no history of diabetes, alcoholism, human immunodeficiency virus infection, or immunodeficiency disorder increases the rarity of this case. This case highlights the role of imaging in diagnosing rib caries, cold abscess, and miliary TB.

Disseminated Tuberculosis in an Immunocompetent State: A Case Report.

BACKGROUND: Tuberculosis is one of the major infectious diseases of mankind and remains a significant health concern, especially in developing countries. Clinical manifestations of TB are broad and sometimes very challenging for clinicians to diagnose early. Tuberculous psoas abscess was generally secondary to spinal tuberculosis or direct extension from adjacent structures in immunocompromised individuals, but tuberculous psoas abscess in the immunocompetent state is very infrequent. In addition, pancytopenia and new onset neck swelling simultaneously make this presentation a very unusual clinical entity in tuberculosis. CASE PRESENTATION: We now present a case of a 21-years-old, unmarried, otherwise healthy girl presented with fever, lower abdominal pain and weight loss for two months. She also noticed painless neck swelling for 15 days. She later had a tuberculous left sided psoas abscess with pancytopenia and a cold abscess on the left side of the neck with no sign of any other apparent focus, according to the evidence. Diagnosis of disseminated TB without lung involvement was established and ATT was started. The outcome was successful on follow up. CONCLUSION: Among the broad spectrum of atypical manifestations of TB, this case report draws attention to its rarity, diagnostic challenge and awareness of the clinical spectrum, especially in developing countries.

Gluteus maximus abscess revealing a tuberculous arthritis: A case report and review of the literature.

Although tuberculosis is a widespread disease in Morocco, musculoskeletal form is relatively rare and even rarer when affects the sacroiliac joint. Tuberculous sacroiliitis remains a challenge for orthopedists owing to its insidious onset and non-specific clinical presentation. Herein, we report the case of a 23-year-old male with a growing mass in his left gluteal area, diagnosed with tuberculous sacroiliitis, based on bacteriological and histological findings. The aim of our work is to draw attention to the importance of continued awareness for early detection and adequate treatment of this very rare entity.

Case Report: Lingual Tuberculosis Reveaed by a Cold Abcess.

Tuberculosis is the most common infectious disease in the world and the lingual location represents less than 1% of extra-pulmonary forms. We report a case of primary lingual tuberculosis which was presented to us in the form of a cold abscess in a 46-year-old alcohol and tobacco drinker weaned for 01 years. Confirmation was histological after biopsy of the lesion. Treatment with anti-tuberculosis drugs for 06 months resulted in a cure. Primary tuberculosis of the tongue is rare and can take several macroscopic forms, including cold abscess which is exceptional. A histological examination after biopsy will make the diagnosis.

Cold abscess as a primary manifestation of thyroid tuberculosis.

Tuberculosis remains the highest cause of infection-related mortality in low- and middle-income countries. Extra-pulmonary tuberculosis is often misdiagnosed because of the nonspecific clinical presentations and gaps in the laboratory assessment. Delayed and misdiagnosis can cause increased risks of morbidity and potential community transmission. Primary thyroid tuberculosis is very rare presentation even in the endemic area. We presented a Case Illustrated of a patient with cold abscess as a primary presentation of thyroid tuberculosis. Difficulty in the diagnosis and treatment were described. Although very rare, atypical presentation of extra-pulmonary tuberculosis in the thyroid gland requires thorough anamnesis and in-depth examination. Clinicians should put high-index suspicion on high-risk patients from endemic areas with medical comorbidity including immunocompromised disease and poor nutritional status. Our report underlines the importance of thorough medical assessment for unusual presentation of thyroid tuberculosis.

BCG-Induced cold abscess as a complication of inadvertent vaccine injection: A case series.

We report a four-month-old girl with a right thigh swelling, an eight-month-old girl with a left thigh swelling, and a five-month-old boy with a left thigh swelling with the final diagnosis of BCG-induced cold abscess as a result of erroneous injection of BCG vaccine into the infants' thigh muscle.

Pott's disease with extensive cold abscess in the abdominal cavity which was misinterpreted as malignancy.

Pott's disease is a distinctive presentation of tuberculosis that occurs in approximately 5% of extrapulmonary cases that progressively developed a voluminous paravertebral abscess. While the disease is marked only by the occurrence of inflammatory symptoms and low-grade pain, the advanced mimics other infections and malignancies. Therefore, early recognition is important for proper treatment preventing deformity of the residual spinal and permanent neurological deficit. We present a 20-years-old woman who experienced low back pain for 2 years and presented with a right-side lump in the abdomen. CT and MRI were performed in this case. CT image showed bone destruction and extensive abscess formation, while on an MRI there was epidural granulation and compacted cauda equina resulting in severe central canal stenosis. To clarify the diagnosis, a chest radiograph and Mantoux test were performed and the patient was confirmed positive for lung tuberculosis. After antituberculosis drug treatment, (Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol) initial phase, the patient had difficulty walking.

Outcome Analysis Of Primary Chest Wall Tuberculosis: A Series Of 32 Cases.

BACKGROUND: Chest wall tuberculosis is a rare disease, and although incidence has decreased further with advances in antituberculosis chemotherapy, it remains prevalent in developing countries. Diagnosis is difficult because pus smears or bacterial cultures of aspirate frequently fail to yield tuberculous bacilli. To discuss the characteristics of this rare disease and suggest an optimal strategy for management, we share our experience with 32 patients managed surgically and with antituberculosis chemotherapy. METHODS: In this descriptive case series we retrospectively reviewed the medical records of 32 patients managed from May 2006 to May 2016. RESULTS: Out of 32 cases of chest wall tuberculosis, 59.4% (n=19) patients had a current or previous history of tuberculosis. Presenting complaints were chest pain, a palpable mass and pus discharge in most patients. A preoperative bacteriologic diagnosis was positive in only 3 patients. Generous abscess debridement was done in 21 (65.63%) cases, abscess debridement and partial rib resection in 11 (34.38%), abscess debridement and partial sternum excision in 7 (21.88%), and clavicle excision in 2 (6.25%) patients. Postoperative wound infection was noted in 1 (3.13%) patient. There were no recurrences. CONCLUSION: Chest wall tuberculosis requires generous debridement of diseased tissue including under lying bone, meticulous obliteration of residual dead space by vascular muscle flap, and negative suction drainage in addition to antituberculosis chemotherapy for good post-operative results with acceptable morbidity and mortality.

Cold abscess of dental origin in a 7-year-old child.

Abscess related to an infected tooth is mostly associated with pyogenic infection, but sometimes, it can be asymptomatic and indicate a chronic condition. This case report shows cold abscess with a draining sinus due to dental origin. A 7-year-old female patient complained of pain with respect to grossly decayed tooth and recurrent swelling with no response to medications. After investigations and management of the lesion, it was concluded as abscess due to chronic granulomatous infection. Cold abscess is a classical manifestation of tuberculosis with no signs of inflammation. More than 60% of cases of this pathology occur in patients below 15 years old. It needs various clinical, histopathological, and laboratory investigations. Although rare, it should be considered as a differential diagnosis when no improvement occurs postroutine therapy to prevent serious complications. Furthermore, various precautions should be taken by the clinicians to prevent cross-infection.

Unusual cervicofacial localization of two subcutaneous tuberculous cold abscesses in an immunocompetent subject.

INTRODUCTION: Subcutaneous tuberculous cold abscesses represent a rare form of extra-pulmonary tuberculosis and their cervicofacial localization is exceptional. The management of this unusual form and location is medico-surgical and must be adapted to avoid progression to complications. CASE REPORT: We report the case of a double cervicofacial localization of subcutaneous tuberculous cold abscesses in an immunocompetent patient followed for pulmonary tuberculosis who benefited from a surgical drainage of the two abscesses with anti-tuberculosis treatment with good clinical evolution. DISCUSSION: The diagnosis of subcutaneous tuberculous cold abscesses is based on a combination of anamnestic, clinical and paraclinical findings. Cold abscesses are most commonly described in patients with disseminated tuberculosis or during human immunodeficiency virus infection, but they may also occur in immunocompetent subjects. Monofocal localization is the most common and the association of several localizations is unusual. The treatment is medical-surgical, combining surgical drainage with anti-tuberculosis treatment. CONCLUSION: Subcutaneous tuberculous cold abscesses should be considered in the presence of any stubborn collection occurring in a context of tuberculosis infection. Early diagnosis is the best guarantee of a cure without complications.

Unilateral Hypoplastic Pelvic Ectopic Kidney Presenting as a Cold Abscess: A Case Report.

Renal ectopia, even though a benign condition, presents diagnostic challenges when its complications arise. Cold abscess in an abnormally sited kidney may, therefore, create a diagnostic conundrum for the clinician. We present the case of a 55-year-old male who had a suppurating ectopic kidney that mimicked an abdominal visceral mitotic lesion necessitating initial laparotomy, reviewed the literature, and highlighted the need to consider the differential diagnosis, especially in patients who have been referred from peripheral hospitals where generous antibiotic therapy has been instituted. We also recommend undertaking a preoperative split renal scintigraphy where available, especially when nephrectomy is considered.

Extrapulmonary Tuberculosis masquerading as chest wall malignancy: Just never ceases to surprise!

With the emergence of the acquired immunodeficiency syndrome, we witnessed a higher incidence of disseminated and extrapulmonary tuberculosis. The infection sites commonly include lymph nodes, pleura, and osteoarticular areas, although any organ can be involved. Given the atypical presentation of the extrapulmonary disease, it poses a significant diagnostic challenge for the physicians; therefore, a high index of suspicion should be maintained, particularly where tuberculosis is endemic. Here we present a case of isolated chest wall tuberculosis in an immunocompetent patient.

Diagnostic dilemma of an isolated inguinal clinical cold abscess - ? Suppurative,? EPTB, ? NTM infection- a rare and interesting case report.

Cold abscess is an abscess without local pain and warmth and it usually accompanies Tuberculosis. The site varied depending upon the organ affected and cervical region is the commonly affected one. Cyto-morphology of cold abscess usually showed caseation type of necrosis, lymphocytes and granuloma with degenerated epithelioid cells. Here we presented an inguinal cold abscess in 9 years old girl with unique cyto-morphology of plenty of neutrophils, foam cells and lymphocytes in fine needle aspiration smear without caseation necrosis and epithelioid cells. Presence of Mycobacterium in the aspirated pus was proved by Ziehl-Neelsen as well as Auramine fluorescent staining. This characteristic cyto-morphology of mycobacterium infection mimicking pyogenic abscess emphasizes the importance of Ziehl-Neelsen staining in all abscess for early specific diagnosis and effective treatment.

Tuberculous cold abscess of sternoclavicular joint: a case report.

Bone and joint tuberculosis is a serious medical problem; tuberculosis of sternoclavicular joint is rare. We present a case of a healthy 37-year old man with sternoclavicular joint tuberculosis. The subject presented with a three weeks history of left sternoclavicular joint painless swelling without fever or weight loss. He had no previous history of pulmonary tuberculosis. Laboratory testing revealed erythrocyte sedimentation rate of 70 mm/hour, C-reactive protein of 30 mg/liter and a normal leucocyte count. Biopsy of the lesion showed caseous necrosis and pus culture revealed Mycobacterium tuberculosis. He was treated with joint debridement and anti-tuberculous medications. Tuberculosis resolved completely but post-infection patients had residual joint arthritis. Tuberculosis may infect unusual joints such as the sternoclavicular joint.

Absceso frío tuberculoso. Revisión de la literatura a propósito de cinco casos en Angola / Tuberculous cold abscess. Literature review on five cases in Angola

RESUMEN Introducción: El absceso frío tuberculoso es la forma clínica más frecuente de tuberculosis cutánea. Objetivo: Familiarizar a los médicos generales con las características clínicas del absceso tuberculoso frío para asegurar su diagnóstico y tratamiento específico en la consulta de Cirugía del Hospital General N'gola Kimbanda en Namibe, Angola en 2018. Método: Se revisó la literatura sobre el tema en bases de datos científicas como Medline, PubMed, SciELO, Scopus, Clinical Key, LILACS con los descriptores: tuberculosis extrapulmonar y absceso frío tuberculoso. Resultados: Los pacientes, tres varones y dos hembras, tres adultos y dos infantes, todos desnutridos, con antecedentes de tuberculosis pulmonar y mal de Pott que fueron enviados a consulta con el diagnóstico de lipoma. En todos los casos se diagnosticó absceso frío tuberculoso, 3 de localización lumbar, 1 toracolumbar y 1 lumbosacra confirmados por microbiología y tratados según los protocolos de las especialidades de Cirugía y Neumología. Conclusiones: Es necesario que los estudiantes de Medicina, médicos generales y especialistas que en su desempeño enfrentan a dichos pacientes dentro y fuera de Cuba se empoderen de las características semiológicas del, también llamado, goma tuberculoso, a fin de identificarlo en los pacientes de riesgo y garantizar su tratamiento médico-quirúrgico específico para evitar la discapacidad y mortalidad asociada a esta temida infección que sigue constituyendo un azote social.

ABSTRACT Introduction: Tuberculous cold abscess is the most common clinical form of skin tuberculosis. Objective: To familiarize general physicians with the clinical characteristics of tuberculous cold abscesses to ensure their diagnosis and specific treatment at the Surgery Department of the N'gola Kimbanda General Hospital in Namibe, Angola in 2018. Method: Literature on the subject was reviewed in scientific databases such as Medline, PubMed, SciELO, Scopus, Clinical Key and LILACS with the following descriptors: extrapulmonary tuberculosis and tuberculous cold abscess. Results: The patients, three males and two females, three adults and two infants, all of them malnourished, with a history of pulmonary tuberculosis and Pott's Disease, who were sent for consultation with a diagnosis of lipoma. In all cases, tuberculous cold abscesses were diagnosed, 3 of them in lumbar location, 1 in thoracolumbar and 1 in lumbosacral locations, confirmed by microbiology and treated according to the protocols of the specialties of Surgery and Pneumology. Conclusions: It is necessary that students of Medicine, general physicians and specialists who face these patients inside and outside of Cuba to gain in knowledge with the semiological characteristics of the tuberculous cold abscess, also known as tuberculous gum, in order to identify it in the patients in risk groups, and to guarantee their specific medical-surgical treatment to avoid the disability and mortality associated to this infection that still constitutes a major issue.