Course Of Antituberculous Therapy Research Articles

Unilateral hearing loss: case report on the insidious consequence of nasopharyngeal tuberculosis

BackgroundNasopharyngeal tuberculosis constitutes 1% of the head and neck manifestation of extra-pulmonary tuberculosis. The rarity of the disease along with its non-specific presentation may pose a challenge in diagnosis.Case presentationWe present a case of a 33-year-old patient who presented with a gradual onset of unilateral hearing loss. Endoscopic examination revealed leukoplakic lesions over the bilateral torus tubarius with audiological assessment revealing a mixed hearing loss in the left ear. Patient completed a 6-month course of anti-tuberculous therapy with a complete resolution of nasopharyngeal lesions and hearing loss.ConclusionWe hypothesize that tuberculosis of the nasopharynx may not only lead to impaired middle ear ventilation but also damage to the ossicular chain and inner ear structures.

Multifocal Tuberculosis Presenting as Mandibular Swelling in a 3-Year-Old Boy: A Case Report


 
 
 
 ABSTRACTObjective: To report a case of multifocal pediatric tuberculosis presenting with mandibular swelling and discuss its etiology, clinical findings, diagnosis, management, and outcome after treatment.
 
 
 
 
 Methods:
 Design: Case Report
 Setting: Tertiary Government Training Hospital
 Patient: One
 
 
 
 
 Results: A 3-year-old boy presented with progressive non-tender, right mandibular swelling for 11 months. Panoramic X-ray exhibited extensive multiple loculations with lytic changes on the mandible. CT Scans revealed a peripherally enhancing hypodense mass with lytic expansion of the right mandibular angle extending across the left mandibular body with an incidental finding of right lung mass. Other extrapulmonary lesions were also detected involving the scapula, pleura with lysis of the adjacent ribs at the level of T7 and T8. Biopsy of the mandibular and lung mass confirmed the presence of caseating and non-caseating granulomas consistent with Koch’s infection. The patient showed significant improvement by the 7th month of a 12-month course of anti-tuberculous therapy.
 
 
 
 
 Conclusion: Multifocal TB can present as simple mandibular swelling, and a thorough workup should look for other involved sites. Early diagnosis in children may prevent debilitating sequelae and improve long-term treatment outcomes.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Tuberculosis of the spine in children – does drug resistance affect surgical outcomes?

BACKGROUND CONTEXTThe emergence of drug resistance has complicated the management of spinal tuberculosis (TB). While it is well known that the medical management of drug-resistant spinal TB is more difficult, the surgical outcomes of the same have not been studied sufficiently, particularly in children. PURPOSETo analyze the surgical outcomes in a cohort of children treated for spinal TB, and to thus assess whether drug resistant (DR) disease is associated with poorer surgical outcomes. STUDY DESIGN/SETTINGRetrospective observational study. PATIENT SAMPLEAll children diagnosed and treated for tuberculous spondylodiscitis at a single center between January 2014 and June 2017. OUTCOME MEASURESSurgical outcomes in terms of neurological status and kyphosis angle at final follow-up, and complication rates. METHODSRadiographic and clinical data of children treated for spinal TB with minimum two-year follow-up were retrospectively analyzed. Data gathered included age, gender, level of spine affected, number of vertebrae involved, neurology (Frankel grade), microbiological reports, duration and type of anti-tuberculous therapy (ATT), details of Orthopaedic management and complications during treatment. In DR cases, the time from presentation to starting of second-line ATT was also assessed. Radiographs were reviewed to note the pre- and post-operative degree of kyphosis as well as the angle at final follow-up. Patients that developed major complications were compared statistically with those that did not. RESULTSForty-one consecutive children (mean age 8.5 ± 4.2 years, 20 boys, 21 girls) were treated for spinal TB with a mean follow-up of 31.2 ± 6.4 months. Fifteen were managed conservatively, of which only one had DR-TB. Of the 26 managed surgically, 13 were managed with first-line ATT and 13 required second-line ATT. Of this latter group, eight had microbiologically proven drug resistance, whereas five were switched to second-line therapy presumptively because of failure to show an adequate response to first-line regimen. At last follow-up, all children had completed the prescribed course of ATT and had been declared cured. Neurological improvement was seen in all but one patient; and at last follow-up, 18 children were Frankel E, seven were Frankel D, and one was Frankel B. 11The mean kyphosis angle at presentation was 32.69° ± 21.37°.The immediate post-operative Kyphosis angle averaged 24.38° ± 15.21°. However, six children showed a subsequent worsening of kyphosis, and the Kyphosis angle at last follow-up averaged 30.96° ± 23.92°. Five children had major complications requiring revision surgery; complications included wound dehiscence, vertebral collapse, screw pull-out and implant breakage. Significantly higher number of patients in the group with complications had required second-line ATT (p < .05). CONCLUSIONSIn a cohort of children treated surgically for spinal tuberculosis, a higher complication rate, and thus poor surgical outcomes, were found to be associated with drug resistant disease.

Levofloxacin based non-rifampicin anti-tuberculous therapy: An effective alternative in renal transplant recipients in resource limited setting.

Rifampicin is one of the most effective components of anti-tuberculous therapy (ATT). Since rifampicin is a hepatic enzyme (CYP3A4) inducer, in a post-renal transplant recipient, the dose of calcineurin inhibitors needs to be up-regulated and frequently monitored. In resource-limited (low- and lower-middle-income countries) setting this is not always feasible. Therefore, we evaluated a non-rifampicin-based ATT using levofloxacin in kidney transplant recipients. We retrospectively studied the medical records of renal transplant recipients diagnosed with tuberculosis in our institute between 2014 and 2017. After a brief discussion with patients regarding the nature and course of ATT, those who opted for a non-rifampicin based therapy due to financial constraints were included in the study and followed for a minimum of 6 months period after the completion of ATT. Out of the 550 renal transplant recipients, 67 (12.2%) developed tuberculosis after a median period of 24 (1-228) months following transplantation, of them, 64 patients opted for non-rifampicin-based ATT. The mean age was 37.6 years. Only 25% were given anti-thymocyte globulin based induction, while the majority (56; 87.5%) of them were on tacrolimus-based triple-drug maintenance therapy. Extrapulmonary tuberculosis was noted in 33% of cases, while 12 (18.7%) had disseminated disease. The median duration of treatment was 12 months and the cure rate of 93.7% (n = 60) was achieved at the end of therapy. Levofloxacin based ATT appears to be a safe and effective alternative of rifampicin in kidney transplant recipients who cannot afford heightened tacrolimus dosage.

A Swollen Leg

Abstract We report a patient with a rheumatic overlap syndrome on hydroxychloroquine and prednisone who developed tuberculous pyomyositis shortly after receiving 9 months of treatment of miliary tuberculosis. Her only presenting symptom was swelling of the left lower extremity without any systemic manifestation, despite extensive radiographic evidence of disseminated abscess formation. Acid-fast bacilli stains and cultures of the purulent material were negative for Mycobacterium tuberculosis (MTB), but polymerase chain reaction confirmed the diagnosis. To our knowledge, this is the first case report of tuberculous pyomyositis that developed shortly after the patient completed a full course of antituberculous therapy. We believe that the concurrent therapy of her rheumatic overlap syndrome with hydroxychloroquine likely led to her treatment failure for MTB and will discuss the possible pathogenesis. Our case also illustrates that MTB can cause significant soft tissue disease without systemic manifestations and that polymerase chain reaction is a valuable diagnostic study.

The Case of a Primary Tuberculosis Complex in a Child With Late Detection

We present a case of late detection and course of the primary tuberculosis complex in a child who was previously in an unknown contact with a tuberculosis patient at the first year of life. The disease onset simulating pneumonia took place at the age of 1 year 8 months. Hereafter, the child did not have any clinical signs of the disease. At the age of 5 years, the child was examined in connection with the hyperergic reaction to tuberculin: the results of computed tomography revealed calcinated foci in the lung tissue and calcifications in the intrathoracic lymph nodes; bronchoscopy revealed infiltrative bronchial tuberculosis. Surgery was performed: video-assisted thoracoscopy, resection of C9,10 part of the left lung with precision removal of the focus in its C6 segment, extirpation of bifurcation, and left bronchopulmonary lymph nodes. The results of the histological examination indicated the chronic course of the tuberculosis process with formation of bronchiectasis and presence of bronchonodular fistulas. After surgery and the main course of antituberculous therapy, a clinical cure with small residual changes was achieved.

Neuro-radiology: a new gold standard investigation for management of central nervous system tuberculosis

Treatment of CNS TB is challenging due to lack of specific biochemical tests and inability to get the pathological sample from deeply located eloquent areas of CNS without causing any neurological deficit. Moreover, it is unnecessary to operate for biopsy in a patient who has presented with a very small granulomatious lesion in brain or spinal cord. In such as situations neuro-radiology helps in managing CNS TB and it may be the only source of establishing diagnosis and evaluating treatment response.Role of radiological investigation has expanded from the initial diagnosis to the therapeutic interventions. In some Muli-drug- resistant (MDR) CNS TB cases, Stereotaxy or USG or CT guided biopsy helps in obtaining pathological sample and drug sensitivity testing. A regular clinical and neuro-radiological follow-up is mandatory during the entire course of anti tuberculous therapy to take prompt decisions to change ATT and to reduce morbidity and mortality associated with CNS TB.

Role of the Infectious Disease Consultant in Management of Patients With Tuberculosis-Associated Ocular Inflammation.

Background. Tuberculosis is a disease with continued worldwide prevalence, morbidity, and mortality. Tuberculosis-associated ocular inflammation (TB-AOI) is a manifestation that can occur with pulmonary or extrapulmonary TB. Evaluation of these ocular presentations and treatment in the United States are limited. Our objective was to describe cases in an urban area and assess the role of the infectious diseases specialist in managing these complex patients. Methods. We performed a retrospective case series of all patients referred to our infectious disease clinic for presumed TB-AOI from 2005 through 2013. Patients with ocular inflammation were determined to have presumed TB-AOI based on clinical presentation with correlative positive tuberculin skin test and/or QuantiFERON-TB Gold. Attempts were made to exclude other diagnoses. Data were collected and analyzed with respect to demographics, ocular manifestations, and treatment. Results. Sixty eyes of 42 patients were included in the study; anterior uveitis was the most common site of involvement. The median age was 46 years, and 33 patients (79%) were foreign born. Forty patients (95%) received a course of antituberculous therapy with 38% experiencing treatment-related side effects. A 6-month duration was recommended in 78% cases. There was improvement or stability of the vision in 42 eyes (74%) of those treated. Conclusions. Ocular involvement is an uncommon but important manifestation of TB. Our data further characterize TB-AOI cases in the United States. Treatment provides significant benefit to properly selected patients. A multidisciplinary approach, with care provided by ophthalmology and infectious disease providers, should be used to allow for the most efficacious treatment.

Erector Spinae Tubercular Abscess.

Dear Editor, We have read with great interest the case report entitled, Isolated Spontaneous Primary Tubercular Erector Spinae Abscess: A Case Report and Review of Literature in the issue of Asian Spine J 2015;9(2):276-280 doi: 10.4184/asj.2015.9.2.276 and we would like to congratulate the authors on their management of the case. However, we would like to make some comments, which we believe will advance the potential contribution of this study [1]. 1. The authors state that until date, there has been only one report [2] on isolation of spontaneous primary tubercular erector spinae abscess [1]. We agree with the authors but we would like to draw attention towards one additional case report related with erector spinae tubercular abscess in a renal-transplant recipient [3]. Indudhara et al. [3] have also reported a case of tuberculous pyomyositis involving the left erector spinae muscle but with no other manifestations of tuberculosis. The diagnosis was suspected from the CT scan appearance and confirmed by microscopy and culture of the pus. In addition, infection was cured through surgical incision and drainage along with antituberculosis therapy [3]. Soft-tissue tuberculosis in renal-transplant recipients has only been reported twice: one patient with isolated pyomyositis involving the erector spinae muscle [3], and one with olecranon bursitis [4]. 2. Muscle involvement without coexisting active skeletal or extraskeletal tuberculosis is a very rare form of extrapulmonary tuberculosis, which manifests with different presentations such as isolated muscle mass, tubercular myositis, isolated muscular abscess and tubercular pyomyositis [5]. The rarity of muscle involvement in tuberculosis has been attributed to various reasons such as a high lactic acid concentration, lack of reticuloendothelial/lymphatic tissue, abundant blood supply, and the highly differentiated state of muscle tissue [6]. Pyomyositis is the least common presentation of extraspinal musculoskeletal tuberculosis and most of the cases in the literature have shown the involvement of a single site [7]. 3. The treatment of antitubercular multidrug therapy (isoniazid [INH], rifampin [RIF], ethambutol [EMB], and pyrazinamide [PZA]) should be started as early as possible, in case histology or culture proves the diagnosis and other noninfectious pathology has been excluded by clinical examination, imaging or laboratory investigations. Soft tissue and muscular tuberculosis can be treated with aspiration and a full course of anti-tuberculous therapy. Recurrence could occur in the absence of a complete course of anti-tuberculous therapy [7]. Consequently, tuberculosis, so called 'The Great Imitator', may present with a variety of nonspecific signs and symptoms. We would like to draw attention to the atypical presentations of tuberculosis that should be kept in mind. A high index of suspicion is necessary for the diagnosis and early detection of rare types of tuberculosis may lead to proper management of patients. Again we appreciate the authors on work which adds to our knowledge of that an atypical presentation of tuberculosis has staged a remarkable comeback in today's world.

Periocular tuberculous disease: experience from a UK eye hospital

Background/aimsTo describe our experience of patients presenting to a tertiary referral adnexal department with orbital or periocular tuberculosis (TB) over a 10-year period.MethodsWe reviewed all patients with a diagnosis of...

Diagnostic value of the QuantiFERON-TB gold assay (T-SPOT.TB test) in patients with pulmonary tuberculosis after a full course of antituberculous therapy

Objectives The study aims to clarify the effectiveness of the T-SPOT.TB test as a method of evaluation of antituberculous (anti-TB) treatment. Background Among the various diagnostic tools of TB disease, the T-SPOT.TB test is the most advanced. It depends on the detection of interferon-g released from sensitized T cells when exposed to Mycobacterium tuberculosis antigens in vitro . Materials and methods The T-SPOT.TB test was carried out for two groups of individuals; the first group included 25 patients diagnosed previously by a positive culture of M. tuberculosis after a full course of anti-TB treatment. The second group included 10 healthy individuals. Results Twenty-one patients (84%) of the first group had a positive T-SPOT.TB test, whereas only four patients (16%) had a negative T-SPOT.TB test. Of the 23 patients with a negative result by culture and microscopy, 19 (82.6%) had a positive T-SPOT.TB test. Conclusion The T-SPOT.TB test is a weak test for use during treatment monitoring. As conversion of IGRA results might be later than smear conversion results of clinical specimens, we should not consider the IGRA test as a surrogate marker of a cure or a predictor of disease relapse.

Giant tubercular brainstem abscess: A case report

Tubercular brain abscesses are uncommon and tubercular brainstem abscesses are rarely reported. Most of these cases occur in immunocompromised patients. We report a case of giant brainstem abscess in a 5-year-old human immunodeficiency virus-seronegative female child who presented with complaints of headache, diplopia and unsteadiness of gait since 6 months. Diagnosis was made by a magnetic resonance imaging scan of brain. The patient demonstrated a remarkable clinical recovery after microsurgery combined with a course of antituberculous therapy. Microbiological and histological findings confirmed the diagnosis of a tuberculous abscess.

High rate of completion of preventive therapy for latent tuberculosis infection among asylum seekers in a Swiss Canton

Preventive treatment may avoid future cases of tuberculosis among asylum seekers. The effectiveness of preventive treatment depends in large part on treatment completion. In a prospective cohort study, asylum seekers of two of the Swiss Canton Vaud migration centres were screened with the Interferon Gamma Release Assay (IGRA). Those with a positive IGRA were referred for medical examination. Individuals with active or past tuberculosis were excluded. Preventive treatment was offered to all participants with positive IGRA but without active tuberculosis. The adherence was assessed during monthly follow-up. From a population of 393 adult migrants, 98 (24.9%) had a positive IGRA. Eleven did not attend the initial medical assessment. Of the 87 examined, eight presented with pulmonary disease (five of them received a full course of antituberculous therapy), two had a history of prior tuberculosis treatment and two had contraindications to treatment. Preventive treatment was offered to 75 individuals (4 months rifampicin in 74 and 9 months isoniazid in one), of whom 60 (80%) completed the treatment. The vulnerability and the volatility of this population make screening and observance of treatment difficult. It seems possible to obtain a high rate of completion using a short course of treatment in a closely monitored population living in stable housing conditions.

Ureterocolonic fistula formation 12 years after a nephrectomy for renal tuberculosis with a staghorn stone

A postoperative ureterocolonic fistula is rare; only two cases have been reported in the past 38 years in the English medical literature. A 77-year-old female with left renal tuberculosis and staghorn stone received a nephrectomy and a 9-month course of antituberculous therapy. Twelve years later, she experienced repeated urinary tract infection and associated pneumaturia despite medical treatment. Cystoscopy revealed yellowish debris in the bladder, and a computed tomographic examination showed an air bubble in the bladder and a highly suspected fistula between the left ureteral stump and sigmoid colon. After a fistulectomy, she completely recovered, and follow-up urinalysis yielded normal results. This case report highlights this rare condition of urinary tract infection secondary to fistula formation from the ureteral stump even 12 years postoperatively. In addition, we compare different imaging techniques and hypothesize that a nephroureterectomy may be indicated for an inflammatory nonfunctioning kidney containing a staghorn stone.

Acute flaccid quadriparesis and distal symmetrical polyneuropathy complicating tuberculosis of the urinary tract

Acute flaccid quadriparesis and distal symmetrical polyneuropathy (DSP) are neurological conditions associated with sudden compression of the cervical spinal cord and damage to peripheral nerves, respectively. Although quadriparesis can result from compressive myelopathy by tuberculosis (TB) of the cervical spine, it has not been reported in patients with TB of the urinary tract, either alone or in combination with DSP. We therefore report the case of a 28-year-old man who developed sudden weakness of the four limbs after 2 months of low grade fever, night sweats, malaise, and weight loss; followed by 2 weeks of low back pain, tingling sensations, and numbness of both hands and feet; all without evidence of compressive myelopathy. A diagnosis of TB of the urinary tract was made following positive Mantoux test and isolation of acid fast bacilli from one of six urine samples, and patient underwent 12 months course of antituberculous therapy with resolution of symptoms and signs of both TB infection and neurological diseass. This report has shown that anti TB therapy is effective in both TB of the urinary tract and the associated neurological complications. This report demonstrates a rare neurological complication of urinary tract Tb and the efficacy of anti TB therapy in both conditions

TUBERCULOUS BRAINSTEM ABSCESS

Tuberculous brainstem abscess is a clinically rare condition with potentially high mortality and morbidity. We present this report to draw attention to the importance of early recognition and adequate treatment of tuberculous brainstem abscess. A 24-year-old man complained of longstanding fever, headache, and weakness followed by development of progressive slurred speech and hemiparesis of the right extremities. Magnetic resonance imaging revealed a large thick-walled cystic lesion lying within the brainstem. The patient demonstrated a remarkable clinical recovery after microsurgery combined with a course of antituberculous therapy. Microbiological and histological findings confirmed the diagnosis of a tuberculous abscess. Despite its rarity, the tuberculous brainstem abscess must be considered in the differential diagnosis of cystic brainstem mass lesions in vulnerable patients. When confronted with progressing neurological deterioration and poor response to antituberculous therapy, stereotactic or microsurgical management should be considered. Microsurgical excision combined with a complete course of antituberculous therapy in our patient led to a good outcome.

Surgery for pulmonary tuberculosis

The role of thoracic surgery in pulmonary tuberculosis, in either a diagnostic or a therapeutic role, is well established. This review aims to underline the current indications for lung resection, surgical strategy and outcomes associated with surgery. There has been a renewed interest in surgery, mainly in the multidrug-resistant tuberculosis (MDRTB) group as an adjunct to medical therapy. Lung resection in this group of patients has been undertaken with acceptable morbidity and mortality, and with cure rates of over 90%. The current strategy favours early surgical intervention for patients with multidrug-resistant tuberculosis to prevent the development of bilateral disease. Early surgery for haemoptysis is advocated, for sometimes it is necessary to operate on these patients without a full course of antituberculous therapy. Medical stabilization and early inpatient surgery is favoured in view of the excessive mortality associated with emergency surgery. There is still no consensus on the management of the bronchial stump at the time of lung resection, although the current trend favours closure, either sutured or stapled, without muscle reinforcement. Lung resection for pulmonary tuberculosis, in carefully selected and prepared patients, is safe with acceptable morbidity and mortality.

Tracheobronchopathia osteochondroplastica presenting as an isolated nodule in the right upper lobe bronchus with upper lobe collapse

Tracheobronchopathia osteochondroplastica is a rare benign condition that is characterized by the presence of bony and cartilaginous nodules in the tracheal and bronchial mucosa. It was first described by Rokitansky (1855), Luschka (1856), and Wilks (1857). The cause of the disease still remains unknown. Most cases are asymptomatic and frequently diagnosed incidentally during routine bronchoscopies and occasionally during difficult intubations or radiologic examinations. Clinical Summary A 55-year-old woman presented with a history of dry cough and left-sided chest pain associated with low-grade fever of 6 months’ duration. She had been given a diagnosis of tuberculous cervical lymphadenitis 3 years previously and had received a course of antituberculous therapy. The general physical and systemic examination did not reveal any significant abnormality. The chest x-ray film showed no abnormalities. The laboratory profile, including sputum for acid-fast bacilli, was negative. Fiberoptic bronchoscopy showed normal tracheal mucosa with a sharp and mobile carina. The right upper lobe bronchus was completely occluded by a hard mass that was difficult to biopsy. The bronchoscopic biopsy report was inconclusive, and the cytology report was negative for malignancy. A computed tomographic scan of the thorax showed occlusion of the right upper lobe bronchus by a calcified mass with no parenchyma lextensio nan dcollaps eo fth elun gdistall y(Figur e1) .A right upper lobectomy was performed. There was an intraluminal tumor occluding the right upper lobe bronchus with an adequate stump available for closure after resection. The gross specimen revealed a hard, polypoid, whitish nodule measuring 1.0 cm in diameter that occluded the right upper lobe bronchus. The lung parenchyma appeared unremarkable. On microscopic examination, the bronchial wall at the site of the nodule showed a polypoidal lesion covered by bronchial epithelium and composed of cartilage and

Successful kidney re‐transplantation in a patient with previous allograft kidney tuberculosis

Opportunistic infections, and in particular tuberculosis (TB), carry substantial morbidity and mortality in solid organ transplant recipients. We report a 39-year-old man who underwent a cadaveric renal transplant. Three months postoperatively, he was diagnosed to have tuberculous infection of his graft kidney manifested as fever and renal impairment. The diagnosis was confirmed by renal biopsy, which showed granuloma formation and positive stain for acid-fast bacilli (AFB). His systemic symptoms responded well to a complete course of anti-tuberculous therapy, but his renal function continued to deteriorate. Graft nephrectomy was performed and the patient underwent a second kidney transplant 1 year later. He remained well and asymptomatic thereafter. No signs of recurrence of tuberculous infection were noted up until the present time. This case illustrates that TB remains an important threat to transplant recipients. Although reactivation of dormant TB is the usual mode of infection, acquisition from the donor graft is also possible. The latter may account for the infection in our case, as our patient had a negative tuberculin skin test and normal chest radiograph prior to transplant. The identification of AFB in the kidney graft less than 3 months postoperatively also suggested that causal relationship. While diagnosing TB in post-transplant recipients is difficult and may require renal biopsy, as in our case, treatment on the other hand is no different from the standard protocols. However, no consensus has been reached on the safety of re-transplantation. Also, the need for graft nephrectomy and chemoprophylaxis remains unclear.

Early-stage ovarian carcinoma combined with pulmonary tuberculosis mimicking advanced ovarian cancer: a case report

In patients of ovarian cancer combined with multiple pulmonary nodules, the diagnosis of metastatic ovarian cancer is always considered. However, benign pulmonary conditions can be discovered instead. An 80-year-old female presented with a rapidly growing ovarian mass, elevated serum CA-125, and multiple pulmonary varying-sized nodular lesions. The pretreatment workup of her lung lesions failed to show a malignant cell, and it also failed to show any evidence of tuberculosis or other infectious diseases. After surgery, her disease was allotted to ‘stage IV’ epithelial ovarian cancer and adjuvant cytotoxic chemotherapy was then used. However, her sputum culture showed positive growth ofMycobacterium tuberculosis4 weeks later. For fear of reactivation of pulmonary tuberculosis, the anticancer cytotoxic chemotherapy was postponed and the antituberculous treatment was given instead. After 6-month course of antituberculous therapy, no active lung lesion was detectable. In conclusion, infectious or inflammatory conditions can mimic metastatic disease and therefore add to the difficulty of stage determination. We recommend that there must be positive cytologic or pathologic results of lung lesions to allot a case of ovarian cancer to stage IV. Furthermore, whenever pulmonary lesions are seen on imaging, the possibility of diagnoses other than metastatic ovarian cancer should always be considered.