Rare Manifestation Of Extrapulmonary Tuberculosis Research Articles

Coeliac lymph node abscess: A case report of a rare manifestation of extrapulmonary tuberculosis

Tuberculosis is a leading cause of death worldwide, especially in developing countries. It can affect any site in the body and have a myriad of presentations making diagnosis challenging. Tuberculous lymphadenitis in the abdomen is rare. We present a case of a 42-year-old man who presented with non-specific abdominal symptoms and was found to have an intraabdominal abscess on computed tomography scan of the abdomen. Endoscopic ultrasound-guided aspiration was performed, and tuberculosis was confirmed. This case highlights the importance of having a high clinical suspicion of tuberculosis even with vague symptoms in tuberculosis endemic countries. This would prevent unnecessary surgery as tuberculosis is responsive to anti-tuberculosis drugs.

Primary Parotid Tuberculosis in a Toddler

Tuberculosis (TB) of the parotid gland is a rare disease and occurs less frequently in children. Re-emergence is seen amongst immunocompromised individuals whose diagnosis may be overlooked, leading to unnecessary surgery. Diagnosis is challenging in the absence of systemic constitutional symptoms and depends mainly on the treating physician having a strong suspicion. We report a rare extrapulmonary manifestation of TB involving the parotid gland in an otherwise immunocompetent child. A 2-year-old girl presented with a mass in the right parotid region that had been present for 3 months. A similar swelling was treated with an antibiotic 3 months prior, but it recurred. The mass was painful, firm, erythematous, and located in the infra-auricular region. Symptoms persisted after 2 courses of antibiotics, after which ultrasonography was performed and the intra-parotid collection was aspirated, which was positive for acid-fast bacilli (AFB). The patient was placed on anti-TB treatments. Although uncommon, TB should be considered in patients with a solitary mass in the parotid gland to avoid unnecessary surgery.

Tuberculous Pericarditis: Clinical, Diagnostic, and Therapeutic Features

Introduction: Tuberculous pericarditis is a rare manifestation of extrapulmonary tuberculosis. Due to the infrequency of this condition, the most effective management approach has not been clearly established. Our study analyzed 14 cases with tuberculous pericarditis treated at Ibn Rochd Hospital in Casablanca over two years from 2020 to 2022. Methods: Medical records of tuberculous pericarditis patients were reviewed. Data on demographics, clinical presentation, diagnostic methods, and treatments were collected. Results were expressed in terms of frequencies, averages, and percentages. Results: The mean patient age was 37.7 years, with 64% males. Common symptoms included fever (50%), chest pain (57%), and dyspnea (92.8%). Clinical signs included right heart failure (35%) and muffled heart sounds (57%). ECG findings showed sinus tachycardia (71.4%) and low voltage (57%). Echocardiography revealed pericardial effusion (78%) and other abnormalities. Pericardial fluid was mostly citrine yellow (64%) and serohemorrhagic (36%). Adenosine deaminase was positive in 57% of cases. GeneXpert confirmed 71% of cases, while pericardial biopsy confirmed 29%. All received antitubercular treatment, with corticosteroids in three cases. In-hospital, 92% showed pericardial effusion regression, but one death due to tamponade occurred. Long term, 21% had effusion recurrence, and 35% transitioned to constrictive pericarditis. Conclusion: Tuberculous pericarditis presents diagnostic challenges. Clinical, radiological, and biological evidence is crucial for diagnosis. Antitubercular treatment is effective, but the risk of constrictive pericarditis remains high, necessitating further research into corticosteroid therapy's role in prevention.

An atypical presentation of CNS tuberculosis manifesting with meningoencephalitis and tuberculoma in a New York taxi driver

Mycobacterium Tuberculous (MTb) meningitis is a rare manifestation of extrapulmonary tuberculosis (Tb) but remains the most common form of Central Nervous System (CNS) manifestation of tuberculosis. It is associated with significant morbidity and mortality yet difficult to diagnose given the low sensitivity and specificity of diagnostic testing with cerebral spinal fluid (CSF) analysis which typically shows CSF findings of lymphocytic pleocytosis, elevated protein, and low glucose and is confirmed by acid fast bacillus (AFB) culture. Here, we describe a case of severe meningoencephalopathy in the setting of disseminated tuberculosis with atypical radiological findings of tuberculoma.

Adolesan Bir Hastada Granülomatöz Üveit ile Seyreden Oküler Tüberküloz: Nadir Bir Olgu Sunumu

Tuberculosis continues to be a significant global public health issue. Tuberculosis most often affects the lungs. However, children are more likely to have extrapulmonary involvement compared to adults. Ocular involvement is a rare extrapulmonary manifestation of tuberculosis. Ocular tuberculosis may affect any part of the eye and can be remain unnoticed due to the lack of clinically evident symptoms or findings, if there is no history of tuberculosis contact or other systemic signs or if these are not questioned. Here, we present an adolescent case who was diagnosed with pulmonary and ocular tuberculosis when investigating the underlying cause of granulomatous uveitis and successfully controlled with four drug regimen anti-tuberculosis and methylprednisolone treatment. In conclusion, ocular tuberculosis is an important cause of ocular morbidity. Diagnosis and follow-up require a multidisciplinary approach.

Clinical Profile of Patients with Tuberculous Arthritis Admitted in a Tertiary Hospital in the Philippines

Background. Tuberculous arthritis is a rare extra-pulmonary manifestation of tuberculosis (TB) that can lead to significant disability when left untreated. This study described the clinical profile of patients with TB arthritis admitted in a tertiary hospital in the Philippines.
 Methods. We reviewed medical records of 65 patients with TB arthritis admitted in the Philippine General Hospital from 2006 to 2019.
 Results. Majority of patients were male (41, 63.0%) and the mean age upon diagnosis was 46.7 ± 1.7 years (20– 85). Majority (33, 50.8%) had underlying co-morbidities including hypertension (16, 24.6%), type 2 diabetes mellitus (10, 15.4%), and chronic kidney disease (8, 12.3%). A history of previous TB treatment (10, 15.4%), intake of immunosuppressive drugs (7, 10.8%), and trauma on affected joints (13, 20.0%) were also reported. Majority presented with chronic mono-arthritis (50, 76.9%) involving the knees (27, 41.5%) and hips (21, 32.3%) with a mean duration of symptoms of 20.9 ± 3.9 months. The most frequent initial diagnosis upon admission was septic arthritis (21, 32.3%). Confirmed septic arthritis (10, 15.6%), pulmonary TB (9, 14.3%), and disseminated TB (4, 6.3%) were also observed. Majority were diagnosed based on positive acid-fast bacilli (AFB) smear, polymerase chain reaction (PCR) for Mycobacterium tuberculosis, or synovium biopsy (34, 54.0%). Anemia (43, 68.3%) and elevated inflammatory biomarkers (erythrocyte sedimentation rate, ESR [36, 97.3%] and C-reactive protein, CRP [40, 87%]) were also seen in majority of patients. The most common radiographic findings on x-ray were joint space narrowing (42, 84.0%), soft tissue swelling (22, 44.0%), and erosions (21, 42.0%). The mean length of hospital stay was 23.8 ± 2.8 days (2–113). Majority underwent surgical interventions (35, 55.6%) including debridement (28, 80.0%) and arthrotomy (25, 71.4%). All received anti-tuberculosis treatment upon diagnosis.
 Conclusion. Majority of patients with TB arthritis in this study were male, with mean age in the 5th decade of life, presenting with mono-arthritis, anemia, elevated inflammatory markers, and radiologic findings of joint narrowing. All patients received medical treatment while more than half underwent surgery. There should be a high index of suspicion for TB arthritis in a patient from an endemic country presenting with chronic mono arthritis in weight-bearing joints to prevent delay in diagnosis and significant joint destruction and disability

Answer to October 2021 Photo Quiz.

We report an unusual pyomyositis with concomitant pulmonary lesions in an HIV-positive patient. Due to the difficulty of collecting sputum, gastric lavage was performed. The abscess in the leg was drained (Fig. 1B in photo quiz case presentation). The gastric lavage and the abscess drainage were analyzed using an acid-fast bacilli smear (Fig. 1C in photo quiz case presentation) and Xpert MTB/RIF assay. Gastric lavage, purulent drainage, and blood culture were positive for Mycobacterium tuberculosis. The typical formation of serpentine cords was demonstrated upon culture of abscess drainage (Fig. 1D in photo quiz case presentation). Gastric lavage was M. tuberculosis nucleic acid positive by Xpert MTB/RIF assay. The diagnosis of tuberculosis (TB) pyomyositis was confirmed. Anti-TB therapy (rifampin) was started. Pyomyositis is the accumulation of purulent material within individual muscle groups, and the most common organisms implicated in pyomyositis include Staphylococcus aureus (1). Typical cases of pyomyositis involve fever and pain, which are specific to a muscle group, generally the lower extremities (1, 2). TB pyomyositis, defined as M. tuberculosis infection of skeletal muscle, is more common in immunocompromised patients, but even in these patients, it is considered to be a rare extrapulmonary manifestation of TB. The clinical manifestations may be insidious, with nonspecific symptoms, such as fever, night sweats, malaise, and weight loss (3). Ohnishi et al. reported three cases of TB pyomyositis in women coinfected with TB/HIV with a CD4 below 200 cells/mm3 (4). Pathogenesis for TB pyomyositis can include contiguous spread, lymphatic or hematogenous spread, and direct inoculation (3, 5). We hypothesize that in this case it was a hematogenous spread because of the absence of trauma or infection, with no evidence of osteomyelitis. TB pyomyositis is very difficult to clinically diagnose and distinguish from other soft tissue diseases. Diagnosis depends on a high clinical suspicion of infection in a susceptible population. TB should be considered in patients who present with soft tissue swelling and pain, particularly if they have an abnormal chest X-ray (6). Drainage through surgery and aggressive anti-TB therapy is normally required (7). The case presented here is noteworthy given the rarity of this manifestation of TB and highlights the need for early diagnosis. With timely diagnosis and adequate clinical and surgical treatment, the prognosis is good. Prompt diagnosis requires a high index of suspicion, especially in immunocompromised patients. Fluid cultures should be sent for acid-fast bacilli staining (Fig. 1C in photo quiz case presentation) and culture (8). In laboratories serving areas of high M. tuberculosis incidence with limited economic resources, cord factor detection (Fig. 1D in photo quiz case presentation) is a fast and valid criterion for identifying these mycobacteria using liquid or solid medium (9).

A Rare Case of Sacral Pott’s Disease

Tuberculosis spondylitis, or “Pott’s Disease”, is a rare extrapulmonary manifestation of tuberculosis involving the spine. Very few cases of tuberculosis with sacral involvement have been reported, particularly in the United States, which may pose a diagnostic challenge for clinicians. We present a case report of extrapulmonary tuberculosis with sacral involvement in a 27-year-old male who initially presented with systemic symptoms thought to be related to a hematologic malignancy

A Case of Calvarial Tuberculosis in an Elderly Male Patient

Tuberculosis (TB) is still endemic in developing countries like Pakistan. Tuberculosis affecting bones account for 1% of all TB infections. Calvarial tuberculosis, a rare manifestation of extra-pulmonary TB, accounts for 0.2%-1.3% of all cases of skeletal TB. Even in developing countries where TB is endemic, cases with this type of TB are not commonly seen. The most commonly involved sites are the frontal and parietal bones, with destruction of both the inner and outer table. Proper diagnosis and timely management help in improving prognosis. Here we describe the case of a 70-year-old male patient with pulmonary and extrapulmonary (calvarial) tuberculosis. The diagnosis was established on histopathological examination with demonstration of Acid-Fast Bacilli (AFB) and typical features seen on computed tomography (CT) scan.

Primary gastroduodenal tuberculosis complicated with acute pancreatitis: a rare case report and literature review

BackgroundTuberculosis (TB) is a major health problem worldwide. Even in highly prevalent countries, primary gastroduodenal tuberculosis is a rare manifestation of extrapulmonary tuberculosis. In recent years, as the incidence of tuberculosis has increased year by year, the occur of gastroduodenal tuberculosis has also increased. Endoscopy is an important tool for diagnosing gastroduodenal tuberculosis. The performance of gastroduodenal tuberculosis under endoscopy is often non-specific, which may imitate other benign or malignant gastroduodenal diseases. Diagnosis of gastroduodenal tuberculosis relies on a combination of endoscopy and guided biopsy.Case presentationHere, we report a rare and interesting case of gastroduodenal tuberculosis with acute pancreatitis. The case initially mimicked gastroduodenal ulcers in morphology and appeared in a middle-aged person with normal immunity but with prolonged fever and abdominal pain. The disease was diagnosed through endoscopy and guided biopsy, and it responded well to antituberculosis drugs.ConclusionsClinicians must remember that even in the absence of immunodeficiency, as in this case, tuberculosis can affect any part of the gastrointestinal tract.

Peritoneal tuberculosis: A case report on a rare cause of tumor marker elevation

Peritoneal tuberculosis (TB) is a rare extrapulmonary manifestation of TB with non-specific clinical characteristics which can produce test results mimicking malignancy and granulomatous peritonitis. This case describes a Filipino 59-year-old, nulliparous woman who was admitted with abdominal pain, ascites, and an elevated CA-125 level. Radiographically, peritoneal nodules were visualized and initial suspicion was high for malignancy. Following a bilateral salpingo-oophorectomy and peritoneal biopsy, histology was negative for malignancy but revealed non-caseating granulomas. She was discharged then readmitted with progressive abdominal pain, and a repeat laparoscopic biopsy yielded specimens with growth of acid-fast bacilli (AFB). A delay in diagnosis and treatment of tuberculous peritonitis increases mortality rates, making early diagnosis with laparoscopic biopsy of paramount importance in prompt diagnosis and initiation of therapy. This patient was initiated on standard anti-TB therapy and experienced no complications.

Disseminated tuberculosis associated with reactive arthritis of Poncet in an immunocompetent patient

Cutaneous tuberculosis is a rare extrapulmonary manifestation of tuberculosis which, like disseminated tuberculosis, commonly occurs in immunocompromised patients. Poncet reactive arthritis is a seronegative arthritis affecting patients with extrapulmonary tuberculosis, which is uncommon even in endemic countries. We report a previously healthy 23-year-old male patient with watery diarrhea associated with erythematous ulcers on the lower limbs and oligoarthritis of the hands. Histopathological examination of the skin showed epithelioid granulomatous process with palisade granulomas and central caseous necrosis. AFB screening by Ziehl–Neelsen staining showed intact bacilli, the culture was positive for Mycobacterium tuberculosis, and colonoscopy revealed multiple shallow ulcers. Disseminated tuberculosis associated with reactive Poncet arthritis was diagnosed, with an improvement of the clinical and skin condition after appropriate treatment.

CYSTIC TUBERCULOSIS OF TALUS IN A CHILD: A CASE REPORT

Tuberculosis of the talus is an unusual presentation of musculoskeletal tuberculosis. It is a rare manifestation of extra-pulmonary tuberculosis (EPTB) and accounts for around 0.1 to 0.3% of total EPTB. Its indolent nature often leads to missed or delayed diagnosis. Thus, prompt diagnosis is of utmost importance as diagnostic and therapeutic delay can worsen the prognosis. We are reporting a case of an 8-year-old boy with tuberculosis of the isolated right Talus with discharging sinus. The X-ray showed a cystic form of tuberculosis. He was treated with first-line antitubercular drugs. The child responded to the chemotherapy and by the end of the12-month course, he was asymptomatic. Thus, early diagnosis and therapy are crucial for good results.

Collateral damage: the impact of the COVID-19 pandemic on the care of a patient with tuberculous neuroretinitis in Lagos, Nigeria

Tuberculous neuroretinis, a relatively rare manifestation of extra-pulmonary tuberculosis, is characterized by optic disc edema, peripapillary and macula swelling, with hard exudates forming a partial or complete 'macular star' While the disease may present a diagnostic challenge for Ophthalmologists, prognosis is usually good, with proper management. The Coronavirus Disease 2019(COVID-19) pandemic has presented a healthcare delivery dilemma in many parts of the world, with poor accessibility to, and under-utilization of, important healthcare services by non-COVID-19-related cases. Herein is a report of a case of tuberculous neuroretinitis in Lagos, Nigeria, whose care was negatively impacted by the ongoing pandemic through the combined factors of the interruption of clinical services during the lockdown, patient avoidance of healthcare facilities and the absence of robust telehealth services. These all culminated in the delayed institution of therapy which may be responsible for the poor visual outcome of no-light-perception.

Breast tuberculosis in Jakarta: Review of 7 cases

Introduction Breast tuberculosis (TB) is a rare manifestation of extrapulmonary TB. It can present with various clinical appearances, mimicking pyogenic abscess or breast cancer. Radiological, laboratory, and histopathology results are often inconclusive. Correct diagnosis of breast TB is required as the treatment consists of mainly antitubercular therapy, with only minimal surgical intervention.Cases We report seven cases of breast tuberculosis that was diagnosed with several diagnostic methods. All patients were treated with antitubercular therapy and showed good response.Conclusion Breast TB should be considered as differential diagnosis of breast lesion, especially in TB endemic countries, which one of them is Indonesia. Â

Rare manifestations of spinal tuberculosis in the Robert J. Terry Anatomical Skeletal Collection (National Museum of Natural History, Smithsonian Institution, Washington, DC, USA)

AbstractToday, osteoarticular tuberculosis (TB) is a rare extrapulmonary manifestation of TB, developing in about 1–3% of patients. Although any part of the skeleton can be affected by tuberculosis, the spine represents the most common site of involvement (~50%). Spinal TB or tuberculous spondylitis typically affects 2 or more contiguous vertebrae, predominantly in the lower thoracic (40–50%) and upper lumbar (35–40%) regions. In the minority of patients (less than 10%), multilevel noncontiguous involvement occurs. By the location of lesions in the vertebra, 5 main types of spinal TB can be distinguished: paradiscal, central, anterior subligamentous, posterior, and articular forms, with the first being the most common type (90–95%). In the palaeopathological literature, the majority of the described spinal TB cases represent the paradiscal form affecting 2 or more contiguous vertebrae in the thoracolumbar region. The aim of our paper is to provide 3 example cases of known age at death, sex, and cause of death from the Terry Collection that show vertebral alterations indicative of rare manifestations of tuberculous spondylitis, and to interpret the observed lesions with regard to their diagnostic value in the palaeopathological practice. Terry No. 468 (23‐year‐old, male, died of pulmonary and spinal TB) exhibited bony changes presumably attributed to the anterior subligamentous form, whereas Terry No. 902 (c. 36‐year‐old, male, died of pulmonary TB) very likely represents the articular and anterior subligamentous types. The vertebral lesions recorded in the skeleton of Terry No. 1124R (49‐year‐old, female, died of pulmonary TB) are suggestive of the paradiscal form with multilevel noncontiguous involvement. Our paper provides palaeopathologists with a stronger basis for identifying tuberculosis in ancient human remains that reveal unusual vertebral alterations resembling that of our cases and, therefore, with a more sensitive means of assessing TB prevalence in past populations.

Cardiac tamponade as a manifestation of extrapulmonary tuberculosis in β thalassemia major patient

Cardiac tamponade is a medical emergency condition. Rapid diagnosis and determination of the etiology with epidemiologic consideration may lead to earlier treatment and improved survival. Occasionally, the etiology may be clearly related to a recognized underlying disease, but the possibility of unrelated etiologies should be considered. Pericarditis tuberculosis, a rare manifestation of extrapulmonary tuberculosis in a non-HIV patient, has to be deliberate as one of the etiology, especially in the endemic area. Here, we report a case of 28 years old male with β thalassemia major presented with excessive exertion breathlessness progressing to orthopnea. Sign of cardiac tamponade was identified from echocardiography which showed large pericardial effusion with swinging heart and right atrial systolic collapse. Pericardiocentesis was performed immediately, drained 870 ml of hemorrhagic fluid from inserted pigtail. The patient was treated with the anti-tuberculosis regimen and oral corticosteroid after real-time polymerase chain reaction of Mycobacterium tuberculosis positivity in pericardial fluid. MRI T2 confirmed no haemosiderosis in patient’s heart. After treatment, the patient responded well and showed clinical improvement.

Tongue tuberculosis: A rare entity

Tuberculosis (TB) of tongue is a very rare extrapulmonary manifestation of TB. A number of different pathologies can mimic this condition, and so TB is often overlooked. Diagnosis requires a high index of suspicion and a prompt clinicohistopathological examination. We report a case of tongue TB which occurred probably because of the habit of brushing teeth with neem twigs (Azadirachta indica).

Piomiositis tuberculosa en un paciente inmunodeprimido

Tuberculous pyomyositis is a rare manifestation of extrapulmonary tuberculosis, most common in immunosuppressed patients, with clinical manifestations similar to pyomyositis of other etiologies, although with a lower age of presentation; notable risk factors include prior tuberculosis infection and pharmacological immunosuppression. Diagnosis depends on a high clinical suspicion of the infection in a susceptible population, given that microbiological isolation is often impossible. The response to treatment and prognosis are good.The case presented here is noteworthy given the rarity of this manifestation of tuberculosis and the slow response to first-line TB management in an HIV patient, despite susceptible microbiological isolation.

Imaging of compound palmar ganglion with pathologic correlation

Compound palmar ganglion, or chronic flexor tenosynovitis, most commonly of tuberculousorigin, is a rare extrapulmonary manifestation of tuberculosis (TB). The flexor synovialsheath is not a common site for TB but, once involved, causes rapid involvement of all flexortendons. We discuss the case of a 70-year-old farmer who presented to us with pain and progressive swelling of the palmar aspect of the wrist. On clinical examination, swelling both above and below the proximal wrist crease was found, with positive cross-fluctuation. Onultrasonography and magnetic resonance imaging, features suggestive of compound palmarganglion were present. The patient underwent surgical resection (extensive tenosynovectomy)and chemotherapy. Post-operative histopatholgical findings correlated with the radiological features.