A follow-up case of relapsing tuberculous spondylodiscitis, complicated with soft-tissues abscess and percutaneous fistula.

Spinal tuberculosis (Pott's disease) is a frequent manifestation of Mycobacterium tuberculosis infection. It manifests as destruction of 2 or more adjacent vertebral bodies followed with destruction of the intervertebral disc, leading to a condition known as spondylodiscitis. Tuberculous spondylodiscitis represents with back pain, fever, joint stiffness, loss of spinal mobility, neurological symptoms, vertebral body collapse, gibbus formation and kyphosis. Persistent Pott's disease might lead to soft tissues abscesses, frequently involving iliopsoas muscle. We, herein, present a 20 years long follow-up case of a Pott's disease patient. The patient got diagnosed as tuberculous spondylodiscitis, almost 10 years after first symptoms onset. She underwent frequent computed tomography and magnetic resonance scanning, with spinal spondylodiscitis being its only significant finding, while lung parenchyma and other organs were not infected. Patient got treated with multidrug anti-tubercular regimen for 18 months in 2 different periods of time; nonetheless she complicated with iliopsoas muscle abscess and percutaneous fistula. Early diagnosis and treatment of spinal tuberculosis (TB) are of great importance in ensuring a good clinical outcome. Delaying the diagnosis and proper management can lead to spinal cord compression, deformity and irreversible neurological complications. Thus, multidrug anti-tubercular therapy must be started timely and the duration of anti-tubercular therapy needs to be individualized. The decision to terminate anti-tubercular therapy should be based on clinical, radiological, pathological and microbiological indices, rather than being based on specific guidelines.

Pulmonary mucinous adenocarcinoma in the presence of reactivated tuberculosis: A case report.

We report the case of a 55-year-old male patient with concomitant pulmonary mucinous adenocarcinoma and reactivated tuberculosis, documented with multiple MSCT (multi-slice computed tomography) changes. The patient initially presented with productive cough, sluggishness, fatigue, voice hoarseness and tuberculosis changes in MSCT. Later, he was diagnosed with pulmonary mucinous adenocarcinoma, which was confirmed by sputum cytology and transthoracic biopsy. Therefore, clinicians should always evaluate the likelihood of simultaneous lung cancer in patients whose MSCT images suggest TB alterations in the lungs, and swiftly decide on the correct treatment and management approach.

Magnetic resonance imaging criteria for thrombolysis in hyperacute cerebral infarction.

PURPOSE: Selection of patients with cerebral infarction for MRI that is suitable for thrombolytic therapy as an emerging application. Although the efficiency of the therapy with i.v. tissue plasminogen activator (tPA) within 3 hours after onset of symptoms has been proven in selected patients with CT, now these criteria are determined by MRI, as the data we gather are fast and accurate in the first hours. MATERIAL AND METHODS: MRI screening in patients with acute cerebral infarction before application of thrombolytic therapy was done in a UCC Mannheim in Germany. Unlike trials with CT, MRI studies demonstrated the benefits of therapy up to 6 hours after the onset of symptoms. We studied 21 patients hospitalized in Clinic of Neuroradiology at University Clinical Centre in Mannheim-Germany. They all undergo brain MRI evaluation for stroke. This article reviews literature that has followed application of thrombolysis in patients with cerebral infarction based on MRI. RESULTS: We have analyzed the MRI criteria for i.v. application of tPA at this University Centre. Alongside the personal viewpoints of clinicians, survey reveals a variety of clinical aspects and MRI features that are opened for further more exploration: therapeutic effects, the use of the MRI angiography, dynamics, and other. CONCLUSIONS: MRI is a tested imaging method for rapid evaluation of patients with hyperacute cerebral infarction, replacing the use of CT imaging and clinical features. MRI criteria for thrombolytic therapy are being applied in some cerebral vascular centres. In Kosovo, the application of thrombolytic therapy has not started yet.

Paradoxical Growth of Optochiasmatic Tuberculoma during the Treatment of Tuberculous Meningitis.

Intracranial brain parenchymal tuberculomas may form paradoxically, days to months after starting antituberculous drug therapy. They may develop in and around optic chiasm and optic nerves after antituberculous treatment as a quite rare occurrence in tuberculous meningitis (TBM) this may lead to severe visual loss if not treated properly. We describe a 5 year-old child with documented TBM being treated with first line antituberculous drugs which developed visual impairment 3 months after starting the treatment. MRI after gadolinium administration revealed multiple perichiasmatic ring enhancing lesions due to tuberculomas. Visual impairment developing in a patient on treatment with antituberculous drugs should give rise to a suspicion of rare optochiasmatic tuberculomas; this necessitates urgent contrast-enhanced MRI of the brain and prompt treatment with steroids.