Unusual presentations of cutaneous tuberculosis.

Cutaneous tuberculosis occurs in 1-2% of world cases of tuberculosis and more common in tropical countries. It presents with different clinical forms. Unusual clinical presentations are not uncommon and awareness of these will help in suspecting and managing these patients successfully. Lupus pernio like lupus vulgaris, tuberculosis of glans penis and lichen scrofulosorum on the distal parts of limbs are presented here because of their unusual clinical presentation.

Tuberculous prostatitis: a condition not confined to the immunocompromised.

SUMMARY: Tuberculous (TB) prostatitis is rare; usually occurring in immunocompromised men. It can mimic benign prostatic hyperplasia (BPH), chronic prostatitis or prostate cancer. This report in an immunocompetent 72-year-old man adds to the clinical spectrum of the five prior reported cases. A low threshold for prostatic biopsy led to a histological evaluation and subsequent microbiological confirmation of TB. This attests to the value of such an approach in arriving at the correct diagnosis and the institution of appropriate anti-tuberculous therapy even amongst immune-competent men.

Case Report: Epididymo-Orchitis due to Mycobacterium tuberculosis.

Genitourinary tuberculosis (TB) is a rare but well-described form of extrapulmonary TB. We present a case of a 35-year-old man from Ethiopia with scrotal swelling and fever who was found to have epididymo-orchitis due to Mycobacterium tuberculosis. The patient presented to the hospital multiple times before undergoing operative debridement with fine needle aspiration and tissue biopsy to confirm the diagnosis. He improved with antituberculous therapy. Patients with TB risk factors presenting with epididymitis that is refractory to empiric antibiotic therapy warrant consideration of TB epididymitis. Our case demonstrates the high index of suspicion required to establish a diagnosis of genitourinary TB.

[Chronic course of latent urogenital tuberculosis].

This is a case report of an elderly patient with urogenital tuberculosis and concurrent tuberculosis of peripheral inguinal lymph nodes. The disease manifested by a fistulous form of inguinal lymphadenitis for 10 years and spread to the kidneys and genitals, but the patient did not seek medical attention. Changes on the glans penis prompted him to consult dermatovenereologist. Due to ineffective treatment and uncovering the scar in the inguinal area the patient was send to an anti-tuberculosis institution, where he was diagnosed with tuberculosis involving the kidneys, prostate, epididymis, penis, inguinal lymph nodes. The patient had a history of a contact with the patient with respiratory tuberculosis. Treatment with antituberculosis drugs produced a positive effect.

[Masks of urogenital tuberculosis as the cause of diagnostic errors].

Urogenital tuberculosis does not have pathognomonic symptoms, so diagnostic errors are quite common. This systematic review of literature was conducted to identify the causes and estimate the incidence of erroneous diagnoses. We critically evaluated some articles in which the authors describe observations of urogenital tuberculosis as rare and unusual because they never encountered this disease, but in fact that were typical manifestations of genitourinary tuberculosis. The authors analyzed and illustrated the features of urinary tuberculosis in patients with pulmonary tuberculosis, differential diagnosis of urogenital tuberculosis and kidney cancer and male genitourinary organs, described errors in the diagnosis of urethral, testicular, penile, prostatic and epididymal tuberculosis. Urolithiasis was described as a mask and concomitant disease of urogenital tuberculosis. Really rare forms of bladder tuberculosis as the cause of diagnostic errors are described. Examples of fatal outcomes of urogenital tuberculosis are given. The authors analyzed cases of granulomatous interstitial nephritis due to tuberculosis infection and tuberculosis of the renal artery as the cause of renovascular hypertension. The most common causes of late diagnosis of urogenital tuberculosis are the absence of a typical pattern and the tendency to manifest under the guise of other diseases.

First reported case of fulminant TB with progression of infection from lungs to the genitourinary region.

Although tuberculosis (TB) is a curable disease, it continues to be one of the leading infections associated with death in the world. Extra-pulmonary TB (EPTB) occurs in approximately 10% of the total cases, presenting with lymph nodes, pleura, bone and genitourinary tract as the most common locations. Genitourinary tuberculosis, the second most common EPTB, is very difficult to diagnose unless there is a high index of suspicion. Isolated TB orchitis or prostatitis without clinical evidence of renal involvement is a rare entity among genitourinary tuberculosis. We presented the first reported case of TB prostatitis and orchitis associated with pulmonary TB and the presence of an acute massive caseous pneumonia in an immunocompetent man. Despite the anti-TB therapy, the patient presented a rapid progression of disease and deterioration of general conditions taking to death, which occurred four days after TB treatment had started. Disseminated TB is a relatively uncommon cause of acute massive caseous pneumonia; however, there should always be suspicion of the disease, since it is a potentially treatable cause. This rare case supports the assertion that TB should be considered as an important differential diagnosis of genitourinary tumors irrespective of evidence of active TB elsewhere in the body.

First reported case of fulminant TB with progression of infection from lungs to the genitourinary region

ABSTRACT Although tuberculosis (TB) is a curable disease, it continues to be one of the leading infections associated with death in the world. Extra-pulmonary TB (EPTB) occurs in approximately 10% of the total cases, presenting with lymph nodes, pleura, bone and genitourinary tract as the most common locations. Genitourinary tuberculosis, the second most common EPTB, is very difficult to diagnose unless there is a high index of suspicion. Isolated TB orchitis or prostatitis without clinical evidence of renal involvement is a rare entity among genitourinary tuberculosis. We presented the first reported case of TB prostatitis and orchitis associated with pulmonary TB and the presence of an acute massive caseous pneumonia in an immunocompetent man. Despite the anti-TB therapy, the patient presented a rapid progression of disease and deterioration of general conditions taking to death, which occurred four days after TB treatment had started. Disseminated TB is a relatively uncommon cause of acute massive caseous pneumonia; however, there should always be suspicion of the disease, since it is a potentially treatable cause. This rare case supports the assertion that TB should be considered as an important differential diagnosis of genitourinary tumors irrespective of evidence of active TB elsewhere in the body.

Tuberculosis of the glans penis mimicking as carcinoma.

Penile tuberculosis (TB) is an uncommon variety of genitourinary TB. It is either primary (via local spread) or secondary (spread of infection from other organs). We encountered a case of rapidly growing penile ulceration, resembling carcinoma. Biopsy revealed the classic picture of TB, which responded well to antitubercular treatment.

[Anthropomorphic features of patients with tuberculosis of the prostate].

INTRODUCTION: Modern TB patient has lost the physical appearance (habitus phtisicus) typical for the previous years. Moreover, patients with different tuberculosis localizations also have different anthropomorphic characteristics. MATERIAL AND METHODS: To determine anthropomorphic characteristics of patients with tuberculosis of the prostate, several parameters were compared between 95 male patients with pulmonary tuberculosis and 49 patients with prostatic tuberculosis. RESULTS: Compared to pulmonary tuberculosis patients, patients with prostatic tuberculosis were significantly more likely to be overweight and have greater waist circumference. Among patients with pulmonary tuberculosis, there were significantly more people of short or very tall stature, while patients with prostatic tuberculosis, on the contrary, were significantly more likely to be of average height (166-180 cm). CONCLUSIONS: The findings regarding body structure of a patient with tuberculosis of the prostate (fat stocky man) could possibly reflect the presence of the metabolic syndrome that may account for the greater susceptibility to urogenital infections.

[Tuberculosis of the prostate].

Genitourinary tract is the second most common site where extrapulmonary tuberculosis (TB) occurs. Genitourinary TB is notable for a latent clinical course and difficult diagnosis. The paper presents clinical observations of two patients treated in a urology department of a general public hospital. One of them was diagnosed with tuberculosis of the prostate, MTB+. In the other, TB of the prostate was suspected based on pathologic assessment of the surgical specimen after surgery for prostate cancer.

Tuberculous prostatitis: mimicking a cancer.

Genitourinary tuberculosis is a common type of extra-pulmonary tuberculosis . The kidneys, ureter, bladder or genital organs are usually involved. Tuberculosis of the prostate has mainly been described in immune-compromised patients. However, it can exceptionally be found as an isolated lesion in immune-competent patients. Tuberculosis of the prostate may be difficult to differentiate from carcinoma of the prostate and the chronic prostatitis when the prostate is hard and nodular on digital rectal examination and the urine is negative for tuberculosis bacilli. In many cases, a diagnosis of tuberculous prostatitis is made by the pathologist, or the disease is found incidentally after transurethral resection. Therefore, suspicion of tuberculous prostatitis requires a confirmatory biopsy of the prostate. We report the case of 60-year-old man who presented a low urinary tract syndrome. After clinical and biological examination, and imaging, prostate cancer was highly suspected. Transrectal needle biopsy of the prostate was performed and histological examination showed tuberculosis lesions.

[REPRODUCTIVE DYSFUNCTION AS A RESULT OF INFECTIOUS AND INFLAMMATORY DISEASES].

Tuberculosis remains an important medical and socio-demographic problem. Chronic inflammation of the prostate gland--of both non- specific and tuberculous etiology--reduces the quality of the ejaculate; this in the initial low level of fertility in a population can have dramatic effects. Infertility can be the first symptom prompting the patient to visit a doctor; and patient is diagnosed with tuberculosis after survey. However, the influence of tuberculosis of the prostate on the functional parameters of ejaculate has not been studied. The positive influence of selenium and zinc preparations on the quality of the ejaculate in patients with chronic nonspecific prostatitis, idiopathic infertility was demonstrated, but the effectiveness of their complex use in tuberculosis of the prostate gland has not been studied.

[Actual issues of pathogenesis of tuberculosis of male genital organs].

Based on a survey of 467 men with genital tuberculosis, following conclusions were made. The presence of morphological signs of nonspecific prostatitis of toxic-allergic genesis in patients with newly diagnosed tuberculosis of the urinary and genital organs proves the possibility of primary infection of the epididymis with Mycobacterium tuberculosis. Primarily isolated epididymal tuberculosis was diagnosed in 21 (4,5%) patients. Tuberculous of testicles is in direct relationship to the duration of the existence of tuberculous infection in the epididymis. Bilateral tuberculous of the epididymis is always combined with tuberculosis of the prostate. Opportunity of both primary and secondary infection of the prostate gland with Mycobacterium tuberculosis can be considered as proved. 15 (3,2%) patients had initially isolated prostatic tuberculosis. Based on clinical observations, exogenous way of introduction of infection in tuberculosis of genital organs in men was not confirmed. The lymphogenous and hematogenous pathways are leading and most common pathways of Mycobacterium tuberculosis in the male genitals. In patients with tuberculosis of the prostate, which is combined with a lesion of urinary organs, without involvement of scrotum in the pathological process, infection of prostate occurs by urinogenous way. Tuberculosis of the seminal vesicles is always secondary; none of the patients were initially diagnosed with isolated process. Based on the clinical manifestations of the disease and a detailed examination of the patient, it is virtually impossible to establish a particular way of infection in the male genitals. The main value of the information about the possible ways of tuberculosis infection consists of fully examination of reproductive system with histological and bacteriological verification of the diagnosis of each genital organs in each man with suspected tuberculosis.

Tuberculosis of the glans penis healing with meatal stenosis.

A 45-year-old man presented with ulceroproliferative lesion of the glans penis. Clinical diagnosis was penile carcinoma and incisional biopsy was performed. Histopathology report came as penile tuberculosis. The lesion healed with antitubercular treatment. Meatal stenosis occurred at 2 months follow-up and was managed with meatotomy.

Isolated tuberculous epididymo-orchitis: an unusual presentation of tuberculosis.

Isolated epididymo-orchitis is an unusual presentation of tuberculosis. A case of bilateral epididymitis and right-sided orchitis with scrotal involvement in a 38-year-old male patient is presented. Strong clinical suspicion of tuberculous etiology was confirmed by appropriate investigations of epididymal biopsy. The patient improved clinically with antitubercular therapy.

Tuberculous epididymo-orchitis mimicking a testicular tumour: a case report.

INTRODUCTION: Isolated tuberculous epididymo-orchitis may closely mimic testicular tumour particularly in patients with no history of systemic TB thereby presenting a diagnostic and treatment challenges. CASE REPORT: A 44-year old man presented with 4 months history of left scrotal mass and had left orchidectomy following a presumptive diagnosis of testicular tumour. Histopathological diagnosis of testicular tuberculosis was subsequently made. Although the patient was thereafter referred for antituberculosis treatment at the local tuberculosis treatment centre, he defaulted after commencing treatment. CONCLUSION: Adequate evaluation of patients with testicular mass by means of abdominal and scrotal ultrasound coupled with fine needle aspiration cytology is critical to diagnostic accuracy, optimal treatment and possibility of avoiding surgery in those with testicular tuberculosis.