Atypical Presentation Of Tuberculosis Research Articles

Atypical presentation of tuberculosis in a 38-year-old daily wage worker: A case report

We present a case of pulmonary tuberculosis (PTB) in a 38-year-old male smoker and alcoholic with an atypical and varied presentation. The patient was a daily wage worker who exhibited symptoms of dry cough and dyspnea but lacked the classic features of fever, weight loss, chest pain, and hemoptysis. Chest X-ray revealed non-homogeneous opacities and multiple small cavities in both lungs, initially raising suspicion for community-acquired pneumonia, atypical pneumonia, or polyangiitis. Acid-fast bacilli (AFB) testing and then line probe assay (LPA) ultimately confirmed the diagnosis of Mycobacterium tuberculosis (Mtb), which is sensitive to isoniazid and rifampicin. This case highlights the variable nature of presentation in tuberculosis (TB), the importance of maintaining a broad differential diagnosis even in the absence of typical symptoms, and the importance of microbiological diagnosis for accurate diagnosis. Risk factors of tuberculosis like smoking and alcoholism, should be considered along with the screening of common comorbidities like diabetes.

Profile of Pulmonary Tuberculosis in People Living with HIV—A Cross-sectional Study

Introduction: The interface between tuberculosis (TB) and HIV is increased in countries like India where both TB and HIV infection are maximally prevalent. Worldwide, TB is the second leading infectious killer after COVID-19. Ten percent of persons infected by both TB and HIV develop TB disease annually and in one-third of them, it turns out to be fatal. HIV- tuberculosis co-infection has an atypical presentation which mostly depends on the degree of immunosuppression. Aims and Objectives: To study the socio-demographic profile, clinical manifestations, and radiological presentation with relation to the CD4 count of patients co-infected with pulmonary TB and HIV. Methodology: This is a hospital-based observational, cross-sectional study done in 100 HIV-PTB co-infected patients from Nov’2021 to Nov’2023. The study was carried out after getting Institutional ethics clearance and Informed written consent from the participants. Results: The majority (74%) were males with 75% belonging to 31–50 years of age. Fifty-eight percent had a CD4 count between 50 and 200 cells/mm 3 . Fever (90%) was the most common presenting symptom followed by cough (85%). Atypical features of TB were present in 52% of the patients. Conclusion: CBNAAT must be indicated as a primary diagnostic modality for detecting TB in PLHIV. Atypical presentations of TB on Chest X-rays are common which are attributed to low CD4 count (≤200) in the present study. Awareness regarding HIV/AIDS, safe sex practices and cough etiquette is the need of the hour.

The spleen as a starting point to the final diagnosis – an atypical presentation of tuberculosis during anti-tumor necrosis factor therapy

The spleen as a starting point to the final diagnosis – an atypical presentation of tuberculosis during anti-tumor necrosis factor therapy

Pulmonary Tuberculosis Mimicking a Lung Cancer: a Case Series

Tuberculosis (TB) is an infectious disease that is caused by Mycobacterium tuberculosis. Despite TB being a preventable and curable disease, it still remains to be one of the leading causes of mortality worldwide and continues to be prevalent. TB can manifest in multiple systems, but its primary target is the lungs. Pulmonary TB can present differently depending on the patient's immune status and comorbidities. One atypical presentation of TB is lung mass, which can mimic lung malignancy and cause diagnostic delays.In this case series, we report on four cases in which TB was initially suspected to be lung malignancy. All four patients had lung masses on diagnostic imaging; microbiological testing was positive in only two of the patients and bronchoscopic abnormalities were seen in two of those. In two of the four cases, caseating granulomas were present on biopsy. All four patients attained clinical and radiologic resolution.In conclusion, despite years of knowledge and the prevalence of TB, atypical presentations can still cause diagnostic delays and unnecessary interventions. This case series provides examples of TB mimicking lung cancer, so considering TB as a differential diagnosis for patients presenting with a lung mass is crucial.

An Atypical Presentation of Tuberculosis in a Kidney Transplant Recipient with Tenosynovitis Attack

An Atypical Presentation of Tuberculosis in a Kidney Transplant Recipient with Tenosynovitis Attack

Atypical presentation of tuberculosis: a case report highlighting the challenges of diagnosis and management

Tuberculosis (TB) remains a significant public health issue worldwide and can present with atypical symptoms, making it difficult to diagnose. Atypical TB symptoms include non-specific symptoms and extrapulmonary TB, and patients with comorbidities may present with atypical TB due to impaired immune function. TB treatment includes antibiotics, which can cause hepatotoxicity, and require close monitoring for signs of liver injury. A 32-year-old female with intellectual developmental disorders was admitted to the hospital with suspected pneumonia and acute respiratory viral infection. Despite initial treatment with antibiotics, her oxygen saturation decreased, and she developed recurrent pneumothorax on the right side and neutrophilic pleuritis. Computed tomography (CT) scans showed increasing infiltrative changes, and bronchoalveolar lavage eventually revealed Mycobacterium tuberculosis DNA, leading to the diagnosis of tuberculosis pneumonia with pleurisy. This case report highlights the challenges of diagnosing TB and the importance of maintaining a high index of suspicion for TB in patients who do not fit the typical profile of the disease. The case also emphasizes the potential for drug-induced liver damage with TB treatment and the need for close monitoring. Early diagnosis and appropriate management are crucial to prevent further complications and improve outcomes in patients with TB.

Cytomorphological study of lymph node lesions at a tertiary care center

Introduction: Lymphadenopathy is one of the most common clinical presentations of patients attending the outpatient department. The degree and pattern of morphological changes depend on inciting stimulus and the intensity of the response. Fine-needle aspiration cytology (FNAC) is an important procedure in establishing the diagnosis of various lymph node lesions. It is a widely accepted, accurate, sensitive, and specific test used in an outpatient setting. Methodology: An observational study was carried out at the department of pathology of a tertiary care hospital in North India from July 2019 to February 2020. A total of 100 lymphadenopathy cases were taken. Smears were stained with Giemsa and categorized according to the cytomorphological pattern. Ziehl - Neelsen (ZN) stain was done in clinically suspicious cases of tuberculosis (TB). Data regarding brief history, site, age, and cytomorphologic features were collected and analyzed. Results: Out of 100 cases of lymph node aspirations, 70 cases showed features of tubercular lymphadenitis followed by reactive lymphadenitis, 29 cases while 1 malignancy. TB was prevalent in all age groups. Conclusion: Lymph node FNAC is a simple, cost-effective investigation with great importance in view of high prevalence of TB in our country, where an atypical presentation of TB can be screened. Purulent aspirate smears which do not show typical features of TB can be dismissed as acute suppurative lymphadenitis in the absence of ZN staining. Acid-fast bacillus positivity in such cases confirms the diagnosis and helps in better patient management.

Sternal swelling presenting as tuberculosis: a case report

BackgroundTuberculosis continues to be a worldwide public health problem. Despite the noted gradual decline in tuberculosis case rates in the UK, clinicians should still be aware of these unusual presentations. Sternal tuberculosis is an uncommon form of extrapulmonary tuberculosis and it can initially be a diagnostic challenge for paediatricians. These lesions can present with nonspecific signs and symptoms that may mimic malignancy.Case presentationWe present a case of a 3-year-old African descent girl with a sternal swelling that was confirmed to be Mycobacterium tuberculosis complex DNA on gastric aspirate. The child had additional radiological investigations that corresponded accordingly. She was started on quadruple antituberculosis therapy with good outcome.ConclusionTuberculosis sternal abscess is as rare finding, especially in developed countries where tuberculosis is not endemic. Tuberculosis may not always present with pulmonary symptoms in children. There should be a high suspicion of tuberculosis, especially in immigrant population presenting with unusual presentations. Our aim is to increase awareness around atypical presentations of tuberculosis in children. Although, tuberculosis is endemic to underdeveloped countries, clinicians should still be aware of presentations in view of current global migration.

Unusual and Rare Cases of Tuberculosis In Immunocompetent Patients

Introduction: Tuberculosis is a major health issue across the world. Extraperitoneal manifestations of tuberculosis have a varied presentation masquerading with other common pathologies. Though it is widespread, diagnosing tuberculosis at unusual sites forms a challenge even in the hands of experienced because of the variance and atypical presentations of tuberculosis at these sites, no standard diagnostic definitions and difficult accessibility of tissue samples. Case series: We report a case series of very rare cases of tuberculosis at unusual sites, treated at our hospital. The period of follow-up ranged from 3 months to one and a half years. All the patients included in this series show signs of improvement at follow-up. Conclusion: High index of suspicion is required to diagnose tuberculosis at unusual sites even in endemic countries. This helps in getting investigations done in the right direction without delay. While CBNAAT and culture are the gold standards for diagnosing M. Tuberculosis, histopathological examination, ADA, CT scan along clinical features can help in correct diagnosis and timely treatment. Reporting of such unusual and rare cases forms a key source of information on research in tuberculosis and collectively make the base for optimization of diagnostic criteria for early detection and treatment.

Fine needle aspiration cytology in assessment of lymph node lesions

Introduction: Fine needle aspiration cytology (FNAC) is widely accepted as the accurate, sensitive, specific and cost-effective procedure in the diagnosis of lymphadenopathy. Tubercular lymphadenitis is one of the most common causes of lymphadenopathy in developing countries like India. Materials and Methods: An observational study was carried out at the pathology department of teaching hospital in Delhi NCR from March 2013 to April 2017. A total of 3392 patients presented in the FNAC OPD of the hospital, out of which 1730 had lymphadenopathies. Smears were stained with Giemsa and categorised into the cytological pattern. Zheil Neelson (ZN) stain was done in all clinically suspicious cases to tuberculosis. Data regarding brief history, site, age, sex, the gross appearance of aspirate and cytomorphologic features were collected and analysed. Results: Out of the 1730 cases of consecutive lymph node aspirations, 17 were excluded from the study due to inadequate material, 979 cases (57.15%) showed features of Tubercular Lymphadenitis followed by Reactive Lymphadenitis, 524 cases (30.58%). Out of the 20 cases which showed HIV positivity 18 showed the presentation of tubercular lymphadenitis. TB was prevalent in all age groups, with the majority of cases affecting people more than 50 years of age. Conclusion: FNAC of lymphadenopathy is of particular importance in view of the high prevalence of tuberculosis in our country, atypical presentation of tuberculosis and because AFB are seen mostly in purulent aspirate smears which do not show granulomas, necrosis or epithelioid cells and which in the absence of Ziehl-Neelsen staining can be dismissed as acute suppurative lymphadenitis. FNAC is a simple, reliable, quick and economical diagnostic tool for peripheral lymph node lesions especially in the quick and simple diagnosis of Tubercular Lymphadenitis. Keywords: Lymph node, Fine needle aspiration cytology FNAC, Tubercular lymphadenitis, Reactive lymphadenitis, Lymphoma.

Tubercular compound palmar ganglion presenting as a severe carpal tunnel syndrome- A case report

Atypical presentation of tuberculosis is not uncommon in developing countries. Among extra-pulmonary sites, tendons are very rarely involved. Compound palmar ganglion associated with tuberculosis is an uncommon condition in which a swelling is present across the wrist joint on either side of the flexor retinaculum. Very rarely such lesion can compress over neural structures and may present as Carpal Tunnel Syndrome. A therapeutic challenge consists of treating disease and its associated presentation. Treatment of choice for such conditions include complete excision of the mass along with the radical synovectomy of the wrist joint and associated flexor tendon sheaths followed by anti-tubercular medications. With early diagnosis and treatment good recovery can be achieved. We present a Case of a large compound tubercular palmar ganglion who presented to us with symptoms of carpal tunnel syndrome which was treated surgically with excision and carpal tunnel release.

AN ATYPICAL PRESENTATION OF TB: A CASE REPORT

SESSION TITLE: Chest Infections 2 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Mycobacterium tuberculosis is the leading infectious cause of death from any single organism in adults. More than two billion people are estimated to be infected with TB worldwide. It usually involves the lungs, but can also present as extrapulmonary TB. (approximately two thirds of people will have pulmonary tuberculosis while less than a third of immuncompetent individuals will have extrapulmonary tuberculosis alone) The diagnosis of extrapulmonary TB can be difficult and often requires a high index of suspicion. We present a case of TB that manifested as a tubercular retropharyngeal abscess. CASE PRESENTATION: A 67 year old female from Vietnam presented complaining of 2 months of worsening posterior neck pain, which progressed to dysphagia to liquids and solids and was associated with weight loss. At presentation she denied any fevers, chills, chest pain, cough, hemoptysis or any other symptoms. On examination she was afebrile, well appearing with normal vital signs, normal pulmonary, cardiac and abdominal examination; but she had left anterior neck tenderness to palpation. Laboratory data was unrevealing. She underwent MRI of the cervical spine to evaluate her neck pain, and the MRI showed C1-C2 retropharyngeal abscess with osteomyelitis of C2 with considerable bone destruction. A Barium swallow study showed a fistulous connection to the retropharygeal space. A CT scan of the chest showed multiple bilateral pulmonary nodules. She underwent incision and drainage of the retropharyngeal abscess with significant improvement in symptoms . Abscess drainage grew Klebsiella pneumoniae. The smear was negative for AFB, but the culture became positive after 21 days for pan-susceptible Mycobacterium Tuberculosis. Gastric drainage and sputum AFB were negative. She was started on high dose steroids and anti-tuberculous treatment after the culture from the retropharyngeal abscess became positive. A PEG tube was placed for nutrition and administration of medications. After 6 weeks of anti-tuberculous treatment and steroid therapy,a fluoroscopy swallow study was repeated which showed resolution of the previously seen fistula and a significant decrease in the size of the retropharyngeal abscess. She completed one year of anti-tuberculous treatment for osteomyelitis related to Mtb. DISCUSSION: Tubercular retropharyngeal abscess is an uncommon cause of neck pain and dysphagia and is an atypical presentation of tuberculosis. It requires a detailed history and physical exam in addition to a high index of suspicion. Early recognition and treatment is essential to prevent serious complications from mediastinitis, airway obstruction, up to paraplegia that could be caused from severe osteomyelitis. CONCLUSIONS: TB is a disease with high prevalence worldwide. TB can have many different clinical presentations and is important to keep it in consideration as differential diagnosis in suspicious cases. Reference #1: Colmenero JD, Jiménez-Mejías ME, Reguera JM, Palomino-Nicás J, Ruiz-Mesa JD, Márquez-Rivas J, et al. Tuberculous vertebral osteomyelitis in the new millennium: Still a diagnostic and therapeutic challenge. Eur J Clin Microbiol Infect Dis. 2004;23:477–83 Reference #2: Marques PM, Spratley JE, Leal LM, Cardoso E, Santos M. Parapharyngeal abscess in children: Five year retrospective study. Braz J Otorhinolaryngol. 2009;75:826–30 Reference #3: Harkani A, Hassani R, Ziad T, Aderdour L, Nouri H, Rochdi Y, et al. Retropharyngeal abscess in adults: Five cases reports and review of the literature. Scientific World Journal. 2011;11:1623–9. DISCLOSURES: no disclosure on file for Ashkin David; No relevant relationships by Megan Ninneman, source=Web Response No relevant relationships by Yoslay Perez, source=Web Response No relevant relationships by Rene Rico, source=Web Response No relevant relationships by Andreas Schmid, source=Web Response

Laryngeal & Lower lung field tuberculosis in pregnancy: A case report

Lower lung field tuberculosis (LLF TB) is atypical presentation of tuberculosis. LLF TB is missed routinely because of confusing clinical and radiological presentation and usually these cases initially treated as pneumonia. In this case report, we observed 25 year pregnant female with dysphonia and cough as presenting feature of LLF TB. Chest radiograph was showing ‘typical’ LLF TB pattern with Cavity in lower zone on right side. Sputum examination for acid fast bacilli was positive in higher grades with ‘laryngeal ulcerative lesions’ in direct laryngoscopy examination. She was treated with recommended four drug regimen and documented ‘cure’ at the end of six months. High index of suspicion is must while evaluating these cases and all possible measures to diagnose underlying tuberculosis to have successful treatment outcome.

Bronchial Wash Gene Xpert MTB/RIF in Lower Lung Field Tuberculosis: Sensitive, Superior, and Rapid in Comparison with Conventional Diagnostic Techniques.

Lower lung field tuberculosis (LLF TB) is an atypical presentation of tuberculosis (TB). LLF TB is common, and a proportionate number of non-resolving pneumonia cases are diagnosed to have pulmonary TB. The prospective observational study was conducted during June 2013 to December 2015 in the Department of Pulmonary Medicine, MIMSR Medical College, Latur, India; the objective of the study is clinical, microbiological, and radiological presentation of LLF TB and the comparison of yield of conventional diagnostic techniques and bronchoscopy-guided modalities in LLF TB. Additional important objective of the study is to find LLF TB in patients with nonresolving pneumonia (NRP). A total of 2,600 patients with pulmonary TB were included in the study after inclusion and exclusion criteria. Ethical clearance was taken from the ethical committee of the institutional review board. Consent was taken from the patients before inclusion in the study. Statistical analysis was done using chi-square test. In the present study, 300 (11.53%) cases of LLF TB of total 2600 pulmonary tuberculosis were included, females constitutes 66.66% (200/300) with mean age of 58.4 ± 11.8 years and males constitutes 33.34% (100/300) with mean age of 56.8 ± 10.6 years. Constitutional symptoms were observed as cough in 93% cases, fever in 83% cases, shortness of breath in 72% cases, anorexia in 91% cases, and weight loss in 84% cases. Radiological assessment of study cases documented the involvement of right lower zone in 84% cases and left lower zone in only 16% cases. In the studied LLF TB cases, 57 cases (20.66%) were diagnosed by routine sputum microscopic examination for acid fast bacilli (AFB) and 80 cases (28%) were diagnosed by induced sputum microscopic examination for AFB. In the study of 170 LLF TB cases, head-to-head comparison between conventional diagnostic techniques (sputum microscopy and Induced sputum microscopy for AFB) made diagnosis in 60 cases, while bronchoscopy-guided sampling techniques (BAL for AFB and BAL for Gene Xpert MTB/RIF) made diagnosis in 155 cases (91.17%) (P < 0.00001). Comorbid conditions such as human immunodeficiency virus (HIV) coinfection in 36 cases (12.00%), Diabetes mellitus in 64 cases (21.33%), and chronic kidney disease (CKD) in 22 cases (7.33%) were observed. Comorbidities were observed in 41.67% of the studied cases and found very significant assessment to have successful treatment outcome (P < 0.00001). In the study of 300 LLF TB cases, 60 cases were having NRP pattern. In LLF TB cases with NRP pattern, bronchoscopy-guided bronchial wash microscopy for AFB made diagnosis in 18 cases (42%), while bronchoscopy-guided BAL for Gene Xpert MTB/RIF made diagnosis in 58 cases (96.66%) (P < 0.00001). LLF TB is usually underdiagnosed because of diverse clinical and radiological presentation, less diagnostic yield of conventional diagnostic modalities, and these modalities used routinely and universally. Bronchoscopy-guided diagnostic techniques are superior, sensitive, and reliable to confirm LLF TB. Gene Xpert MTB/RIF in bronchial wash samples is found to be best diagnostic modality in evaluating LLF TB and should be used routinely to have successful treatment outcome. A proportionate number of NRP cases are having LLF TB and a high index of suspicion is a must while evaluating these cases.

Clinical conundrums: Atypical presentations of tuberculosis

We present four cases of atypical presentations of tuberculosis: TB meningitis with secondary myelofibrosis, tuberculous prostatic abscess, tuberculous aortitis, and tuberculous midline neck swelling.

Cannon ball appearance on radiology in a middle-aged diabetic female.

Pulmonary tuberculosis is commonly presented as cavitary lesion and infiltrations. It commonly involves upper lobe. Lower lobe involvement is less common. Various atypical presentations of tuberculosis on radiology are reported like mass, solitary nodule, multi lober involvement including lower lobes. Atypical presentations are more commo in patients with immunocompromised conditions like Diabetes Mellitus, anemia, renal failure, liver diseases, HIV infection, malignancy, patients on immunosuppressive therapy. Cannon ball presentation of pulmonary tuberculosis is extremely rare and not so common. Common causes of cannon ball presentation in lung are metastasis, fungal infections, Wegener's grannulomatosis, sarcoidosis, etc. We report here a case of middle year female with diabetes mellitus presented with atypical symptoms with cannon ball appearance on radiology and found to be of tuberculosis in origin. Thus any patients with immunocompromised condition can present with atypical manifestation of tuberculosis either clinically or radiologicaly in high endemic countries for tuberculosis.

Psychiatric misleading features of fatal pathologies: Legal implications

Summary Some cases of fatal pathologies may be presented on non-specific clinical symptoms. Unusual exam-findings can lead to some pitfalls and death occurred unfortunately. In this context, we report autopsy cases of miliary tuberculosis and acute pancreatitis misdiagnosed and we discuss the doctor's responsability. Case 1 N.M. is a 24-year-old lady. She was admitted with fever of forty days’ duration associated with headache and anorexia. Examination and radiological investigations did not show any abnormalities. The patient was symptomatically medicated and allowed to return home. After one week, she was discovered dead in her bed. The diagnosis of miliary tuberculosis was confirmed by histological examination after the necropsy. Case 2 A 22-year-girl with history of mental retardation, consulted twice in the emergency room, for inhabitual agitation. She was treated each time symptomatically without any improvement. Death occurred after two days. The forensic autopsy with the histological tests confirmed the diagnosis of necrotic-hemorrhagic pancreatitis. Conclusion Our two cases report highlights the necessity to be aware about atypical presentation of tuberculosis and acute pancreatitis that can lead to sudden death.

Pulmonary vein compression by paravertebral abscess: An atypical presentation of tuberculosis

Tuberculosis is a common disease in developing countries. It can cause dyspnea due to primary involvement of lungs with pulmonary Koch's, but one of the uncommon presentations may be solely due to compression of pulmonary veins (PVs) and/or left atrium resulting in exertional dyspnea resembling cardiac disease. Though there are case reports of lung metastasis, pulmonary artery aneurysm and left atrial myxoma causing PV compression, in literature PV compression due to cold abscess is extremely rare. Here, we report a case of paravertebral cold abscess causing symptoms effectively due to PV compression who got cured with anti-tubercular therapy.

Multifocal Tubercular Osteomyelitis with Tubercular Breast Abscess: An Atypical Presentation of Tuberculosis.

Tuberculosis of spine is common in a developing country like India. However, involvement of spine at multiple levels along with involvement of rib and tubercular breast abscess in an immunocompetent patient without any pulmonary involvement is extremely rare. Here we report a case of 53-year-old immunocompetent lady who presented with quadriparesis and MRI (magnetic resonance imaging) of spine revealed multiple lesions involving cervical, thoracic, lumbar, and sacral region without any involvement of intervertebral disc. On detailed examination she was found to have a lump in right breast. Fine needle aspiration cytology of both paravertebral collection and breast lump revealed presence of acid fast bacilli. She was put on antitubercular drug for one year and she responded well to therapy.

English

SUMMARY: Atypical presentations of tuberculosis are known. We present here a case of reactive polyarthritis due to tuberculosis. Patient was treated with four drugs anti Tuberculous regime which led to complete resolutions of symptoms. INTRODUCTION: Tuberculosis (TB) is a major public health problem. It ranks second leading cause of death from infectious diseases. In year 2012 estimated global annual incidence of TB was 8.6 million cases, out of which 2.3 million were occurred in India and 1.3 million death occurred globally. 1,2 Atypical presentation of TB can be contributing factor for delayed diagnosis, morbidity and mortality.3 We reporting here case of inflammatory polyarthritis turned out to be reactive polyarthritis due to tuberculosis. So high index of suspicion and early treatment led to successful outcome.