Antitubercular Treatment Research Articles

Drug rash with eosinophilia and systemic symptoms syndrome: A prospective study at a tertiary health-care center

Abstract Purpose: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome can be fatal if there is delay in diagnosis and discontinuation of causative drug. It is commonly linked with anticonvulsants and antibiotics. Understanding typical ocular manifestations can aid in early diagnosis and treatment. The main aim of this study is to provide an overview of common ocular manifestations of DRESS syndrome along with identifying the medications responsible and determining age and gender predilection. Methods: This is a 2-year observational study from June 2018 to June 2020. 37 patients recruited from ophthalmology OPD were thoroughly examined, and diagnosed in consultation with the microbiology and dermatology departments. Data required were collected by systematic examination of medical records. Patients diagnosed with DRESS syndrome having redness, itching, watering of eyes, diminision of vision, lid swelling, discharge, pain, and foreign body sensation were included in the study. Patients with no drug history, immediate drug hypersensitivity reactions, steven- Johnson syndrome were excluded. Results: Common ocular manifestations observed were tarsitis (14%), madarosis (12%), ulcerative blepharitis (10%) and conjunctivitis (10%), squamous blepharitis and keratoconjunctivitis (9%) along with other rare findings. Common triggering drugs were anti tubercular treatment (46%), carbamazepine (24%), dapsone (5%), antibiotics (11%). Mean age group affected was 42.05 years with peak between 11-20 years and slight female preponderance of 54%, with males being 46%. Conclusion: Knowing common ocular manifestations of DRESS syndrome and the drugs triggering is crucial in preventing serious consequences. Though treatment is supportive and steroids, key is to withdraw the causative drug early.

Isolated Tubercular Abscess in Immunocompetent Children

Background: Tuberculosis (TB) is a common disease, especially in low-income countries, with a varied clinical spectrum involving multiple organs. Although liver abscess can be seen in 70% of patients with miliary tuberculosis, isolated tuberculous liver abscess (ILTA) is rare in immunocompetent children. Liver involvement, though seen in up to 70% of patients as a part of miliary TB, isolated tuberculous liver abscess (ITLA) is rare in 13 children. Objective: The present systematic review focuses on demographic parameters, clinical presentations, duration of antitubercular treatment, and the need for surgical intervention and recurrence in children with tuberculous liver abscess. Methods: A comprehensive search was done in major databases PubMed and Google Scholar using defined search terms encompassing case reports or case series on isolated tubercular liver abscess in children. The identified reports underwent screening by three different authors for inclusion and exclusion criteria. Results: The median (interquartile range [IQR]) age of presentation was 9.5 (6.5) years, with a slightly higher prevalence in females (59%). The most common presenting symptom was fever (95%), followed by abdominal pain (68%). Hepatomegaly was seen in 90% of cases and jaundice in 16%. The median (IQR) duration of antitubercular treatment was 6 (4) months and surgical intervention was required for 14 (63%) children. The resolution time of the ITLA varied across the children, with a median (IQR) time being 2 (7) months. Conclusion: Pediatric tubercular liver abscess requires a high index of suspicion, particularly in endemic countries like India. Children with liver abscess should be evaluated for TB, if response to initial management is poor. Early diagnosis and prompt treatment with systemic antitubercular treatment are associated with a favorable outcome.

A case series of three infants having pulmonary tuberculosis

Progression of primary pulmonary tubercular infection to active disease is not common in infants. Bacterial pneumonia is usually an imposter and its suspicion usually delays a definitive diagnosis of pulmonary tuberculosis and starting antitubercular treatment. Although congenital tuberculosis infection from infective mother is a possibility but most commonly, they acquire postnatal disease by contact with an infectious adult source. We are sharing our experience of three infants referred to our side who were being treated as bronchopneumonia for a period of 15 to 20 days, and subsequently were diagnosed with post primary pulmonary tuberculosis for a period of 1 year.

Current Trends in the Management of Port-Site Infections: A Case Series and a Review of Published Work.

Introduction Laparoscopic techniques have become standard for many surgeries, offering benefits such as quicker recovery and less pain. However, port-site infections (PSIs) can occur and pose challenges. PSIs can be early (within seven days) or delayed (after three to four weeks), with delayed PSIs often caused by non-tuberculous mycobacteria (NTMs). NTMs are difficult to treat and do not respond well to antibiotics, leading to prolonged and recurrent infections. Guidelines for PSI management are limited. This summary highlights a case series of 10 patients with PSIs, discussing their treatment experience and presenting a treatment algorithm used at our institute. Methods This is a retrospective study (2015-2020) on chronic port-site infections (PSIs) in laparoscopic surgeries. Data were collected on patient demographics, surgery type, prior treatment, and management at the institute. Results The study analyzed 10 patients with chronic PSIs following laparoscopic surgery between 2015 and 2020. Laparoscopic cholecystectomy was the most frequent index surgery. Three patients had a history of treatment with varying durations of anti-tubercular therapy, one of whom had completed anti-tubercular treatment prior to presentation. Complete surgical excision with histopathological examination and fungal, bacterial and mycobacterial cultures were performed. Seven of the 10 patients were treated with oral ciprofloxacin and clarithromycin combination therapy for three months, two were treated with culture-based antibiotics and one was treated with anti-tubercular therapy. All patients improved on treatment.Themean follow-up period was52 ± 9.65 months, with no relapses being reported. Conclusion Port-site infections (PSIs) are troublesome complications of laparoscopic surgery that can erode the benefits of the procedure. Delayed PSIs caused by drug-resistant mycobacteria are difficult to treat. Improved sterilization methods and thorough microbiological work-up are crucial. Radical excision and prolonged oral antibiotics are effective treatments. Clinicians should avoid empirical antibiotic therapy to prevent antimicrobial resistance.

A Case Report of Anti-Tubercular Treatment Induced Acute Liver Failure Intubercular Lymphadenitis

A Case Report of Anti-Tubercular Treatment Induced Acute Liver Failure Intubercular Lymphadenitis

Nonhealing oesophageal ulcer: a case report.

This case report presents the case of a 50-year-old male with dysphagia and a burning sensation at the epigastrium. Endoscopy and histopathological examination showed ulceration at the esophagus and granulomatous inflammation, respectively. Computed tomography showed enlargement of the prevascular and paratracheal group of lymph nodes. However, the acid-fast bacilli stain at the ulcer site was negative. The diagnosis could be confirmed only after 2 months of the antitubercular treatment trial, which significantly potentiated ulcer healing. Esophageal tuberculosis may result from a secondary infection caused by systemic dissemination following a pulmonary disease or as a primary infection. In this case, it likely resulted from lymphatic dissemination via prevascular and paratracheal lymph nodes manifested mainly as dysphagia. Tuberculosis should be considered as one of the differential diagnoses in areas of limited resources. Clinicians may have to rely on clinical judgement and/or the patient's response to standard antitubercular treatment to make a definitive diagnosis.

A Rare Case of Meningoencephalo-Myelitis with a Tubercular Origin

Tuberculosis (TB) can affect any bodily system including the central nervous system (CNS). CNS involvement in Tb is fairly uncommon with poor prognosis due to its high mortality and morbidity. Though meningoencephalitis is a frequent presentation of TB, myelitis along with it is rare. Due to the lack of detailed information about meningoencephalo-myelitis, the risk factors and prognosis of these patients are not fully understood. We report such a rare instance of tuberculosis involving the brain, meninges and spinal cord. The patient was a 13-year-old female with the complaints of fever, both lower limb weakness and urinary retention. The diagnosis was made based on the patient’s medical history and physical examination which showed meningeal syndrome, spinal cord and cranial nerve involvement. The diagnosis was confirmed by the analysis of cerebrospinal fluid, magnetic resonance imaging of the brain and spinal cord, and biochemical evidence of tuberculous infection. The patient had a marked clinical improvement and complete neurologic recovery after anti-tubercular treatment and high doses of systemic corticosteroids. The purpose of presenting the case is to share the bizarre presentation of CNS tuberculosis, a diagnostic and therapeutic emergency. Early diagnosis and immediate management may help with the unfavorable prognosis and our report hopes to shed light on it. J Medicine 2023; Vol. 34, No. 2(1) Supplement: 225

Unusual coexistence: Allergic bronchopulmonary aspergillosis and pulmonary tuberculosis- A rare case report

: Allergic Bronchopulmonary Aspergillosis (ABPA) is an allergic hypersensitivity reaction to the ubiquitous fungus Aspergillus that can cause inflammation and damage to the respiratory system. This condition predominantly occurs in individuals with long-standing airway disease, such as bronchial asthma or cystic fibrosis. While Acid-fast bacilli Mycobacterium tuberculosis causes tuberculosis (TB). ABPA and TB can coexist in the same patient. The coexistence of these two conditions can make the diagnosis and treatment more challenging. This is because some of the symptoms of ABPA, such as cough and wheezing, can be similar to those of TB, and both conditions can cause lung damage. A 21-year young male was admitted with a six-month history of low-grade fever, cough with expectoration, atypical chest pain, and progressive breathlessness. On examination, the patient had bilateral diffuse rhonchi with coarse crepitation, and his chest X-ray showed bilateral heterogeneous opacities with cavities in the left upper and middle zone. Further evaluation revealed a total serum IgE of 3074 IU/L (Normal <100) and elevated levels of Aspergillus fumigatus-specific IgE and IgG. A high-resolution CT of the thorax revealed bilateral upper lobes with tree-in-bud opacities and centrilobular nodules, leading to a diagnosis of ABPA. A sputum sample was sent for an AFB smear, which was positive.Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus fumigatus that most commonly affects people who have bronchial asthma or cystic fibrosis. However, diagnosis can be challenging as patients may not respond to standard treatment, and the symptoms can overlap with those of other respiratory diseases. Therefore, clinicians need to maintain a high index of suspicion for ABPA in at-risk patients and consider appropriate screening tests.This case highlights the rare co-existence of active pulmonary TB and ABPA, which can make diagnosis and treatment challenging. However, with appropriate management, including anti-tubercular treatment and corticosteroid therapy, the patient showed marked improvement in his condition. Clinicians should consider the possibility of multiple comorbidities in patients presenting with respiratory symptoms, and appropriate evaluation and management should be undertaken to achieve optimal outcomes.

Epidemiological characteristics and risk factors of multidrug-resistant tuberculosis in Luoyang, China.

We aimed to examine the prevalence of multidrug-resistant tuberculosis (MDR-TB) in Luoyang, China, identify related risk factors, inform clinical practices, and establish standardized anti-tubercular treatment regimens. We conducted a retrospective analysis of high-resolution melting curve (HRM) data from 17,773 cases (2,748 of which were positive) between June 2019 and May 2022 to assess the prevalence of MDR-TB and to identify its associated risk factors. Between June 2019 and May 2022, out of the 17,773 HRM results, 2,748 were HRM-positive, and 312 were MDR-TB cases. The detection rates for HRM-positive and MDR-TB were 17.0 and 12.1% for males, and 12.4 and 8.2% for females, respectively. The MDR-TB detection rate was higher in the urban areas (14.6%) than in the rural areas (10.6%) and more common among individuals under 51 years of age (14.1%) than those over 50 years of age (9.3%). Notably, the rate of detecting MDR-TB was 18.3% higher in new male patients than in new female patients, which was at 10.6%, and this difference was statistically significant (p < 0.001). Moreover, the rate of MDR detection in females who had received anti-tuberculosis treatment (21.3%) was higher than that in males (16.9%). In the multivariate model that considered the results of the sputum smear and detection time, MDR-TB was positively correlated with a history of tuberculosis (TB) treatment, being male, being younger than 51 years, and living in urban areas. Local TB infections are complex and diverse; therefore, more comprehensive monitoring methods are needed to curb the spread of MDR-TB.

A solitary intracranial rich focus with early meningeal involvement: A correlative image

•Rich foci are caseating brain tuberculous (TB) granulomas surrounding the immigrated TB bacilli.•Rich foci are hypothesized as an underlying pathological mechanism of TB meningitis.•The hypothesis is based on necropsy studies and has rarely been depicted in vivo.•Ruptured foci discharge their contents into the neighboring subarachnoid space.•Discharged contents trigger a T cell response, leading to inflammatory meningitis. A 24-year-old man presented to the emergency department with a 2-day history of fever and headache, not responsive to over-the-counter medications. He reported a previous history of latent tuberculosis, for which he received antitubercular therapy a couple of years ago. Positive results were obtained from interferon-γ release and adenosine deaminase (ADA) assays, but chest computed tomography (CT) was unremarkable. The patient had unremarkable general and neurologic examinations. Brain CT demonstrated a left-sided focal lesion that delineates perfectly post-contrast administration, besides an adjacent area of meningeal enhancement at the Sylvian sulcus (Figure 1). Cerebrospinal fluid analysis revealed monocytic pleocytosis, an elevated protein level, marked hypoglycorrhachia, and positive ADA activity. Based on the data obtained thus far, we concluded that the patient had an early focal tuberculous meningitis (TBM) caused by a rupturing rich focus, consistent with the natural history of TBM that has rarely been confirmed in vivo (Supplement 1) [1Rich AR McCordock HA. Evidence for the presence of ribonucleic acid in the cytoplasmic bodies that appear in the hepatic and adrenal epithelial cells of man in acute infection.Bull Johns Hopkins Hosp. 1933; 52: 5-37Google Scholar, 2Donald PR Schaaf HS Schoeman JF. Tuberculous meningitis and miliary tuberculosis: the Rich focus revisited.J Infect. 2005; 50: 193-195https://doi.org/10.1016/j.jinf.2004.02.010Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar, 3Be NA Kim KS Bishai WR Jain SK. Pathogenesis of central nervous system tuberculosis.Curr Mol Med. 2009; 9: 94-99https://doi.org/10.2174/156652409787581655Crossref PubMed Scopus (100) Google Scholar]. Subsequently, the patient was started on antitubercular treatment using INH, RIF, PZA, and EMB for 2 months. After which, PZA and EMB were discontinued, while INH and RIF were continued for an additional nine months. The focus with the associated TBM resolved substantially following treatment with no evidence of recurrence over a 2-year follow-up.

Identification of factors associated with non-adherence and discontinuation of antitubercular drugs in patients with tuberculosis

The effectiveness of the anti-tubercular treatment (ATT) depends on adherence to the proposed highly effective therapeutic scheme. When the patient starts ATT and fails to come to the healthcare facility for more than 30 consecutive days from the date scheduled for his return, it is considered abandonment. The objective was to identify the difficulties associated with non-adherence and abandonment of the ATT regimen and evaluate the regulation of anti-tuberculosis drugs in Kyrgyzstan. Patients with tuberculosis make the decision to abandon treatment because they are unaware of the time needed, the continuity of treatment, and for reasons of the disappearance of signs and symptoms. The use of alcohol and illicit drugs has a poor prognosis for the treatment, factors that predispose patients to abandon the treatment and prolong the drug therapy. The majority of the patients discontinue treatment because of adverse effects, contributing to the interruption of treatment, so patients should be assisted regularly. To strengthen the requirements for the quality of purchased anti-tuberculosis drugs, when drawing up the technical specification of the government decree of Kyrgyzstan, it is necessary to give preference to drugs that have been prequalified by World Health Organization or evaluated by strict regulatory authorities.

Feasibility and acceptability pilot of video-based direct observed treatment (vDOT) for supporting antitubercular treatment in South India: a cohort study

ObjectivesThe objective of this study was to assess the feasibility and acceptability of video-based anti-tuberculosis (TB) treatment adherence support in patients with TB (PwTB) in South India.DesignAn exploratory cohort.SettingParticipants were...

Evaluation of clinical profiles, imaging findings and antituberculosis treatment outcome in granulomatous mastitis: An Indian scenario

BackgroundThe management of choice for granulomatous mastitis (GM) has yet to be determined but few studies have demonstrated that anti-tubercular treatment (ATT) could be an effective alternative therapeutic option. Hence, the objective of the current study is to determine the clinical feature, radiological imaging findings, and histopathological examination results exhibited by GM and tuberculosis (TB)-proven GM as well as to evaluate the ATT clinical outcome in GM patients. MethodsThe study was performed on 68 GM patients who were referred to the department of pulmonology by the breast clinic (from January 2018 to August 2021). Study populations were categorized into two groups GM and TB-proven GM patients and all were prescribed with standard ATT regimen and were continuously followed up. SPSS version 25 was employed for statistical assessment. ResultsOur study showed that 6 patients from GM and 4 patients from the TB-proven GM group got relapsed. For patients who displayed partial remission, ATT treatment was started after assessing the side effects potential. 14.6% (n = 6) and 7.4% (n = 2) patients who initially demonstrated partial remission were also completely cured. ATT treatment curable rate was determined to be 90% (n = 37) and 81.5% (n = 22) for GM and TB-proven GM patients correspondingly. Therefore, the current study demonstrated nil significant differences between groups. ConclusionThe current study warrants that ATT therapy could be an effective and better treatment of choice for GM patients irrespective of their clinical condition.

Effect of adjunct Vitamin D treatment in vitamin D deficient pulmonary tuberculosis patients: A randomized, double blind, active controlled clinical trial

BackgroundSince, Vitamin D [1α,25(OH)2D)] enhances antimicrobial activity of Innate immunity and modulate Adaptive immune responses, simultaneously, so it play a potential role for balanced immune activity against Mycobacterium tuberculosis and restricting tissue injuries within the TB patients.(Chun et al., 2011) 9 We aimed to determine the role of adjunct Vitamin D treatment on the outcome of pulmonary tuberculosis patients and evaluated the effect of Vitamin D administration on Differential Leucocyte Count, Erythrocyte Sedimentation Rate, serum Adenosine deaminase, serum C- reactive protein, Oxygen saturation (SpO2) and Body Weight in Vitamin D deficient pulmonary tuberculosis patients. MethodsWe conducted a prospective, interventional, randomized, double blind, parallel group, active controlled clinical trial. Newly diagnosed Vitamin D deficient pulmonary tuberculosis patients were randomly assigned to intervention group (received standard anti-tubercular treatment with adjunct Vitamin D3) and control group (received standard anti-tubercular treatment without adjunct Vitamin D3). Total four doses [each dose of 2.5 mg (100000 IU)] of Vitamin D3 were given, orally. First dose was given within 7 days of starting anti-tubercular treatment and second, third, fourth dose were given at 2, 4 and 6 weeks respectively. At the time of enrollment, we measured all baseline characteristics. During follow-up, we measured the study variables and monitored adverse events at 2, 4, 6, 8 and 12 weeks. Our safety parameter was serum corrected calcium level to assess the risk of hypercalcemia. ResultsTotal 130 pulmonary TB patients, 65 patients in each group, were analyzed. Our study results showed that decrease in Neutrophil count was statistically significant with small effect sizes at every time point of measurement and increase in Lymphocyte count was statistically significant with small and moderate effect sizes at 4, 6 and 8 week for intervention group than for control group. Decrease in erythrocyte sedimentation rate was statistically significant with small effect sizes at 6 and 8 week, decrease in serum adenosine deaminase and serum C- reactive protein was statistically significant with moderate effect sizes at 4, 6 and 8 week for intervention group than for control group. Increase in Oxygen saturation was statistically significant at 4 week with small effect size and increase in body weight was statistically significant with small effect sizes for intervention group than for control group. No case of hypercalcemia was reported. ConclusionOur findings suggest a potential role of adjunctive Vitamin D3 to accelerate resolution of inflammatory responses and improvement in clinical outcomes of pulmonary TB patients. Trial registrationThis trial is registered with Clinical Trials Registry - INDIA (http://ctri.nic.in) with CTRI Number - CTRI/2021/11/037914. Place of studyRoom Number 27, first floor out-patients department (OPD) and inpatient Wards, fourth floor, Department of Respiratory Medicine, Uttar Pradesh University of Medical Sciences, Saifai, Etawah (U.P.), INDIA.

Multibacillary, cavitary tuberculosis in an immunocompetent child perpetuating to family members - A Case Report

Cavitary tuberculosis in the immunocompetent paediatric age group is not a common occurrence. The cavitary condition of the disease relates to a high bacillary load and such patients are highly infectious. If not treated early, it can cause perpetuation of infection to close contacts in the family who also can eventually turn positive for tuberculosis (TB). Here is a case of an eleven-year-old girl with a history of cough for 2 months present throughout the day, associated with yellowish, non-blood-tinged sputum, fever and chills. The Ziehl Neelson stain revealed acid fast bacilli 3+. Sputum culture by MB/BacT automated system flagged positive on day 12. The MPT64 antigen test confirmed Mycobacterium tuberculosis. The PPD skin test was significantly positive in family members. The child improved with antitubercular treatment and her family members were negative for AFB and chest X-ray findings. Open cases of tuberculosis with cavitary lesions in the paediatric age group need to be recognized early with a high index of clinical suspicion and treated along with contact tracing of close contacts.

Disseminated Tuberculosis with Poncet’s Disease Masquerading as Systemic Lupus Erythematosus – A Case Report

Tuberculosis (TB) rheumatism (Poncet’s disease) is defined as a polyarthritis associated with extrapulmonary TB in which there is no evidence of bacteriological involvement of the joints. We report a case of 21-year-old female whose initial clinical and laboratory investigations were suggestive of inflammatory arthropathy. The case was complicated by weak anti-nuclear antibody positivity of anti-proliferating cell nuclear antigen (+) antibodies, suggestive of systemic lupus erythematosus. However, after clinical examination and investigations, the patient was diagnosed as a case of disseminated TB with Poncet’s disease. The patient was started on anti-tubercular treatment and showed improvement at the end of 1st month of treatment. The case highlights that Poncet’s disease should be considered as one of the differentials while dealing with cases of unexplained or prolonged arthralgia.

Nutritional status and adherence to anti-tubercular treatment among tuberculosis patients in a community development block of Eastern India

BackgroundUndernutrition is a risk factor for developing tuberculosis (TB) and adherence to treatment leads to successful treatment outcomes. ObjectivesTo assess the nutritional status and adherence to treatment among tuberculosis patients in Bhatar Community Development Block of Purba Bardhaman district, West Bengal, India. Material & methodsA cross sectional descriptive study was conducted among all the 82 tuberculosis patients registered between April to June, 2021, under NTEP in Bhatar tuberculosis unit (TU), who completed at least 1 month of therapy. Nutritional status was assessed based on BMI and adherence to treatment was evaluated by interviewing with a validated version of Morisky Medication Adherence Scale (MMAS-8-Item). Data was analysed using SPSS v23. ResultsAmong the 82 subjects, 51 (62.2%) were found to be underweight and overall high level of adherence to treatment was found among 51 (62.2%) of study subjects. Subjects aged >45 years (AOR 3.686, 95% CI: 1.147–11.842) and having extra-pulmonary Tuberculosis (AOR 8.539, 95% CI: 1.305–55.871) were significantly associated as being adherent to treatment. ConclusionHealth education, awareness and more vigilant monitoring is still needed so that TB patients can be cured successfully. Special attention needs to be given on the nutritional status of the TB patients.

Effects of the Modified Antitubercular Treatment Regimen on Renal Function in Patients With Chronic Kidney Disease and Pulmonary Tuberculosis: An Observational Study.

Chronic kidney disease (CKD) increases an individual's vulnerability to infections like tuberculosis. Doses of pyrazinamide and ethambutol are modified to treat such individuals. Additionally, the renal function tends to decline with advancing age. Therefore, it is crucial to study the effect of antitubercular drugs on renal function in youngand elderly patients. The primary objective of this study was to determine the change in serum creatinine levels at six months from baseline in two study groups that included patients aged ≤50 and >50 years. The secondary objectivewas to determine changes in estimated glomerular filtration rate (eGFR) and BMI six months from baseline. We recruited 40 patients with CKD and pulmonary tuberculosis from Srirama Chandra Bhanja (SCB) Medical College and Hospital, India. Each participant received the modified doses of antitubercular drugs. Their serum creatinine, eGFR, and BMI were assessed at baseline, two and six months.Participants had a mean age of 50.93±9.83 years. The median changes in serum creatinine and eGFR values from baseline were -0.19 and -0.23 mg/dl and 4.16 and 3.93 ml/min/m2 for the two study groups, respectively. Furthermore, the differences in BMI from baseline were 1.91 and 2.14 kg/m2, respectively, for the two groups. The renal function was found to be improved after six months of treatment with modified antitubercular drugs. The intergroup comparisons were not statistically significant. We conclude that the modifiedregimen helps effectively cure pulmonary tuberculosis and significantly improves renal function in CKD patients. Further studies are required togeneralize these findings.

Benign breast cyst in a young male patient diagnosed on cytopathology: Report of a rare case

Abstract Fine needle aspiration cytology (FNAC) is a widely accepted procedure for evaluating breast masses. Cystic lesions in female breasts are common. However, they are incredibly uncommon in male breasts, especially in cytology. Here, we report a rare benign breast cyst diagnosis on FNAC in a 26-year-old male patient without associated gynecomastia. A 26-year-old male patient presented to surgery outpatient department with left breast swelling for 3 months. He had no history of pain, nipple discharge, or fever. The patient, however, was on antitubercular treatment for pulmonary tuberculosis. On physical examination, a small diffuse 5–6 mm lump was palpable in the left breast. Ultrasound revealed a soft small tissue lesion in the superior aspect of the left areola with the suspicious flow on color flow Doppler following which FNAC was advised. Aspiration yielded scanty fluid. On microscopy, smears showed low cellularity comprising few monolayered sheets and small aggregates of benign ductal epithelial cells admixed with a fair number of cystic macrophages in a fluid background. There was no evidence of malignancy. Thus, a cytologic diagnosis of a benign breast cyst was rendered. This is the first case report describing the cytology of a benign breast cyst diagnosed in a male patient as young as 26 without associated gynecomastia. We report this case because of the rarity of this condition and to create awareness that breast cysts should also be kept in mind when dealing with male breast masses, thus avoiding unnecessary surgery, especially in a young men.

Prevention of relapse in drug sensitive pulmonary tuberculosis patients with and without vitamin D3 supplementation: A double blinded randomized control clinical trial.

The immunomodulatory effects of vitamin D are widely recognized and a few studies have been conducted to determine its utility in the treatment of tuberculosis, with mixed results. This study was conducted to see if vitamin D supplementation in patients with active pulmonary tuberculosis (PTB) in the Indian population contributed to sputum smear and culture conversion as well as the prevention of relapse. This randomized double-blind placebo-controlled trial was conducted in three sites in India. HIV negative participants aged 15-60 years with sputum smear positive PTB were recruited according to the Revised National Tuberculosis Control Program guidelines and were randomly assigned (1:1) to receive standard anti-tubercular treatment (ATT) with either supplemental dose of oral vitamin D3 (60,000 IU/sachet weekly for first two months, fortnightly for next four months followed by monthly for the next 18 months) or placebo with same schedule. The primary outcome was relapse of PTB and secondary outcomes were time to conversion of sputum smear and sputum culture. A total of 846 participants were enrolled between February 1, 2017 to February 27, 2021, and randomly assigned to receive either 60,000 IU vitamin D3 (n = 424) or placebo (n = 422) along with standard ATT. Among the 697 who were cured of PTB, relapse occurred in 14 participants from the vitamin D group and 19 participants from the placebo group (hazard risk ratio 0.68, 95%CI 0.34 to 1.37, log rank p value 0.29). Similarly, no statistically significant difference was seen in time to sputum smear and sputum culture conversion between both groups. Five patients died each in vitamin D and placebo groups, but none of the deaths were attributable to the study intervention. Serum levels of vitamin D were significantly raised in the vitamin D group as compared to the placebo group, with other blood parameters not showing any significant difference between groups. The study reveals that vitamin D supplementation does not seem to have any beneficial effect in the treatment of PTB in terms to the prevention of relapse and time to sputum smear and culture conversion. CTRI/2021/02/030977 (ICMR, Clinical trial registry-India).