Tubercular Granuloma Research Articles

Tubercular choroidal granuloma development despite anti-tubercular treatment: managed with anti-VEGF and oral steroids.

Tubercular choroidal granuloma development despite anti-tubercular treatment: managed with anti-VEGF and oral steroids.

Isolated Tubercular Epididymitis: A 10-Year Series

Introduction: Genitourinary tuberculosis (TB) is considered a common form of extrapulmonary TB, being second only to lymph node tuberculosis, which is the most common site. Isolated TB of the epididymis is rare, and diagnosis of epididymal TB can be challenging. In this study, we report our series of isolated TB of the epididymis. Materials & Methods: We retrospectively collected the outpatient and inpatient records of histologically confirmed epididymal tuberculosis. Data including age, clinical presentation, examination findings, and diagnostic tests were reviewed and analyzed. Results: A total of 56 patients were diagnosed to have isolated tuberculosis of the epididymis during the 10-year study period. The mean age was 33 years. The clinical presentation included a hard nodule in the epididymis (100%), hydrocele in 16 (28.5%), posterior scrotal sinus in 6 (10.7%), and sensitivity in 14 (25%) and fever in 3 (5.3%). Four (7.1%) patients had bilateral epididymal nodules, 30 (53.5%) had left-sided, and 22 (39.2%) had right-sided involvement. Scrotal exploration and epididymal biopsy were performed in 16 (28.5%), and unilateral epididymectomy was performed in 40 (71.4%). The histopathological examination revealed a typical tubercular granuloma in all these patients. All patients were put on anti-TB drugs. Conclusions: Isolated TB of the epididymis is a rare disease. Treatment with anti-TB drugs remains the first-line intervention in all cases. Surgery is indicated in cases of failure of pharmacological treatment or the development of complications.

Bilateral choroidal mass: Are we dealing with tuberculosis?

Abstract A 27 year old female was undergoing treatment for suspected viral meningitis in medicine department and referred for eye examination for decrease in vision in left eye. Fundus examination showed multiple bilateral choroidal mass with a normal anterior segment. Fundus fluorescein angiography (FFA) was confirmatory for bilateral choroidal granuloma and with a provisional diagnosis of miliary tuberculosis, High-resolution computed tomography (HRCT) thorax and contrast-enhanced magnetic resonance imaging (CEMRI) brain was done which revealed miliary mottling in both lungs with vertebral involvement and ring lesions with focal asymmetric enhancement respectively. A diagnosis of bilateral multifocal choroiditis with choroidal tubercular granuloma was established following a positive Mantoux report. Hence, unilateral or bilateral mass lesions should not be missed as a possibility of tubercular granuloma with or without systemic presentation in Indian subcontinent.

Pathologic-anatomical Changes in the Comorbidity of Eimeriosis and Tuberculosis in Domestic Chicken and Decorative Pheasants (Phasianus colchicus L., 1758)

The study of patho-anatomical changes is essential in identifying pathological processes and diagnosing especially comorbid pathologies. The aim of this study was to reveal pathological changes and differences in the spontaneous comorbidity of tuberculosis (Mycobacterium avium) and eimeriosis (Eimeria spp.) in adult chickens and ornamental pheasants. The paper highlighted the results of pathological-anatomical changes in adult domestic chickens (n = 17) and ornamental pheasants (n = 5) with spontaneous comorbidity of eimeriosis and tuberculosis. Mycobacteria was detected using bacterioscopy of smears-prints from fragments of organs and Eimeria oocysts were detected by the Füllenborn flotation method. In pheasants, tubercular granulomas were found in the intestine, liver, and spleen in combination with scarring and swelling of the wall and mesentery, and venous stasis in the mesenteric vessels. In addition, hematomas and organ destruction in the liver and spleen were found in pheasants. In domestic chickens, tuberculous granulomas and steatosis were found in the liver. In the intestines, there were indications of mucocatarrhal inflammation, edema, hyperplasia, and small hemorrhages in the area of the cecal-intestinal diverticulum. Tuberculous nodules, internal hemorrhages around the perimeter of the tubercle, and devascularization were observed in the spleen. The present study revealed notable differences in the pathological and anatomical changes resulting from the comorbidity of eimeriosis and tuberculosis in domestic chickens and pheasants.

RARE CASE OF BILATERAL TUBERCULAR SYNOVITIS OF THE KNEE JOINT.

Aim-To describe rare case of Bilateral tubercular synovitis of the knee joint. Musculoskeletal involveme Background- nt in tuberculosis is seen in about 19 % of the case. Joint Tuberculosis is a disease of usually one joint. Although pulmonary Tuberculosis may be absent,patients may present with symptoms of anorexia, weight loss, evening rise of temperature even in extra-pulmonary tuberculosis. 30 yr old male patient presented with acute onset bilateral Case Descriptiontubercular synovitis of both knee joints. The Acid fast bacilli was isolated from both knee joints. Histopathology examination of the synovium did not show tubercular granuloma. However Gene Xpert of the sample showed low grade tuberculosis which was sensitive to rifampicin. Hence this is a rare case in itself,as such case presentation for tuberculosis has not yet been described in the literature. Bilateral tubercular knee joint synoviti Conclusion- s with systemic symptoms of tuberculosis can be rare case presentation of tuberculosis. Bilateral Clinical Significancetubercular knee synovitis can be one of the differential diagnosis of bilateral knee synovitis

Posterior segment involvement in systemic lupus erythematosus – A series from South India

Purpose: To report the spectrum of posterior segment manifestations and visual outcomes in a large series of patients with systemic lupus erythematosus (SLE). Methods: Retrospective study at a tertiary referral eye center in south India between 2016 and 2022. Results: Charts of 109 patients diagnosed to have SLE were retrieved from our medical database. Only nine cases of SLE (8.25%) had posterior segment involvement. The male: female ratio was 1:8. The mean age was 28 years. Unilaterality was the most common presentation in eight cases (88.89%). Lupus nephritis was the most common systemic presentation in five cases (55.56%). Antiphospholipid antibodies (APLA) positivity was seen in two cases (22.22%). Ocular manifestations included microangiopathy (cotton wool spots) in one case, occlusive retinal vasculitis with cotton wool spots in four cases (five eyes), optic disc edema with combined venous and arterial occlusion (one case), central retinal vein occlusion with cotton wool spots and hemorrhages (one case), macular edema (four cases), posterior scleritis with optic disc edema and exudative retinal detachment in the posterior pole (one case), and tubercular choroidal granuloma (one case). Treatment included systemic steroids, hydroxychloroquine sulfate (HCQS), and immunosuppression in all cases, blood thinners in two cases, and laser photocoagulation in four cases. HCQS-related retinal toxicity was not seen in any of the 109 cases. Ocular manifestation was the initial presentation of SLE in one case. Visual outcome was poor in three cases. Conclusion: Presence of posterior segment findings in cases with SLE may suggest a severe systemic disease. Early detection and aggressive treatment result in better visual outcomes. Ophthalmologists could play a vital role in guiding systemic therapy.

Primary Submandibular Gland Tubercular Sialadenitis: A Case Report

Tuberculosis of the submandibular gland is a rare pathology, the diagnosis of which is difficult, given the non- pathognomic clinical presentation and the absence of diagnostic guidelines, the portal of entry can be by hematogenous route or through the excretory canal of the gland. We present the case of a 33-year-old patient who presented with recurrent submandibular sialadenitis without explanation. In order to make a diagnosis a submandibulectomy was performed. The histological study showed a tubercular epitheliogigantocellular granuloma; the patient was put on antitubercular drugs for 6 months with a good evolution.

Histopathological spectrum of liver lesions at autopsy: A cross sectional study

Liver is the principal site of many metabolic activities and is vulnerable to many metabolic, toxic, microbial and circulatory insults. It is frequently involved in metastatic spread of malignancies from all parts of body. This study aimed to analyze histopathological spectrum of liver diseases in autopsy cases, and correlate with the clinical findings wherever available. It was an observational study conducted over a period of 2 years on 283 autopsy cases in department of Pathology of a tertiary care teaching institute in central India. Liver specimens were included in study irrespective of age, sex and cause of death. After fixation in 10% formalin the sections from representative area were submitted for processing, Hematoxylin and Eosin-stained sections were subjected for microscopic examination. Total 283 liver autopsy cases studied showed predominance of male (68.65%). Maximum cases were in the age group of 21 to 30 years (20.14%) followed by 31 to 40 years (18.28%). Fatty change was evident in a majority (32.08%) of the cases while a remarkable (26.49%) number of cases showed changes of congestion on histological examination. Massive hepatocellular necrosis and midzonal necrosis were seen in 2 cases each. Tubercular granulomas and metastasis of adenocarcinoma were seen in 3 cases each. Histological analysis of liver is important learning objective for pathologists to study silent diseases of liver which are incidentally seen in histopathology.

INHALED FOREIGN BODY OR ENDOBRONCHIAL TUBERCULOUS GRANULOMA? : ABOUT A CASE

Tuberculosis is a public health problem. Endobronchial localization of tuberculosis is rare. Its endoscopic aspects are diverse and often misleading and can pose a problem of differential diagnosis such as a tumor or a foreign body in children. Chest CT helps in diagnosis and bronchoscopy remains the most reliable examination with biopsy. early treatment helps to avoid complications including bronchostenosis. We report the case of a tubercular bronchial granuloma in an infant hospitalized in pediatric intensive care for suspected inhalation of a foreign body.

Commentary

Commentary

Bacillary layer detachment in a patient with serpiginoid choroiditis.

Bacillary layer detachment in a patient with serpiginoid choroiditis.

Amelanotic choroidal melanoma presenting as tubercular granuloma

Amelanotic choroidal melanoma presenting as tubercular granuloma

Adjunctive Intravitreal Anti-vascular Endothelial Growth Factor and Moxifloxacin Therapy in Management of Intraocular Tubercular Granulomas

ABSTRACT Purpose To report pre and post treatment levels of VEGF-A in the aqueous humour of patients with intraocular tubercular granulomas and study the effect of a combined intravitreal anti-VEGF bevacizumab and moxifloxacin therapy on their regression. Methods Aqueous samples of 10 consecutive patients with intraocular tubercular granulomas obtained before and after initiating treatment were subjected to ELISA for analysing intraocular VEGF-A levels. Intravitreal injections of bevacizumab and moxifloxacin were given weekly till complete regression of these granulomas. All patients received the usual four-drug ATT and oral corticosteroids. Results Mean baseline VEGF-A level was 1004.27±411.40 pg/ml (401.32-1688.95) that reduced significantly to 27.62±46.86 pg/ml (6.9-131.83) at the last injection. Meannumber of intravitreal injections was 3.1 (2-4). We found significant correlation of decreasing levels of aqueous VEGF-A with the clinical regression of these tubercular granulomas. Conclusions Intraocular TB granulomas have high levels of VEGF-A. Weekly intravitreal injections of anti-VEGF bevacizumab with moxifloxacin as an adjunct to the standard care may cause prompt regression of tubercular granulomas. Abbreviations TB: Tuberculosis; IOTB: Intraocular tuberculosis; VEGF: Vascular endothelial growth factor; RD: Retinal detachment; Mtb: Mycobacterium tuberculosis; ATT: Antitubercular therapy; AMD: Age-related macular degeneration; SRF: Subretinal fluid; ELISA: Enzyme immunosorbent assay; PCR: Polymerase chain reaction; ONH: Optic nerve head; MDR-TB: Multidrug-resistant tuberculosis; pg/ml: picogram/milliliter; ESR: Erythrocyte sedimentation rate; CECT: Contrast enhanced computed tomography; DNA: Deoxyribonucleic acid; RNA: Ribonucleic acid; BSL: Biosafety level; BCVA: Best corrected visual acuity; HM: Hand movements; KP: Keratic precipitates; PSC: Posterior subcapsular cataract; PS: Posterior synechiae; CRA: Chorio-retinal atrophy; IVMP: Intravenous methyl prednisolone; OCT: Optical coherence tomography; RPE: Retinal pigment epithelium; FFA: Fundus fluorescein angiography; ICG: Indocyanine angiography; RAP: Retinal arterial proliferans.

Metastatic Tuberculomas along a Nonfunctioning Ventricular Catheter

AbstractA unique case of tubercular meningitis, developing shunt complication, is being reported. We present a pediatric patient with disseminated tubercular granulomas along the ventricular catheter of a nonfunctional ventriculoperitoneal shunt.

A five year histopathological study of granulomatous lesions at a tertiary care centre

Introduction: Granulomas are common findings in biopsy of various organs. Granulomas are a characteristically focal circumscribed collection of histiocytes along with lymphocytes and giant cells. Objectives: Present study was undertaken to note the frequency and etiology of granulomatous inflammation in various organs by means of histopathology examination. Materials and Methods: The prospective study was conducted for five years (January 2011- December 2015) in pathology department of a medical college hospital. The study includes total 510 biopsies which were showing granulomatous origin. Results: Out of 510 total biopsies, largest number 430 biopsies diagnosed as tubercular inflammation (84.31%), followed by leprosy (5.09%), fungal origin (2.74%), parasitic (1.32%) and cases of granuloma of unknown etiology (1.78%). Conclusion: Most of the granuloma are of infective origin and tubercular granuloma is most common type of etiology in biopsies which shows granulomatous inflammation and lymphnode is the most common affected site. Key words: Granulomatous inflammation, Tuberculosis, Histopathological examination, ZN staining.

Yellow Subretinal Lesions following Initiation of Antituberculosis Therapy in A Tubercular Choroidal Granuloma: A Sign of Paradoxical Worsening?

ABSTRACT Purpose To describe the presentation and management of atypical subretinal lesions following initiation of antitubercular therapy for a tubercular choroidal granuloma. Case report An 18-year-old female was diagnosed with choroidal granuloma and shallow exudative retinal detachment in the left eye. Biopsy from a cervical lymph node was positive for tuberculosis. She was treated with antitubercular therapy (ATT) and oral steroids. After one week of therapy exudative detachment increased markedly and discrete yellowish-white subretinal lesions appeared first in the inferior periphery, then temporally and later involved the macula leading to a drop in visual acuity. A diagnosis of paradoxical worsening was considered and she was managed with a higher dose of oral corticosteroids, intravitreal methotrexate and intravitreal ranibizumab. The granuloma healed and the subretinal lesions as well as exudative detachment gradually resolved with improvement in visual acuity. Conclusion Subretinal yellow-white lesions may develop as a paradoxical response to ATT.

Is there a change in trend towards pyogenous spondylodiscitis compared to tubercular spondylodiscitis in India–A study of percutaneous biopsy evaluation in spondylodiscitis

BackgroundIn Indian subcontinent where tuberculosis is endemic, the spinal infection was thought to be due to mycobacterium tuberculosis in most of the cases. Hence there is a practice of treating these patients with empirical antitubercular treatment. However, recent guidelines advice biopsy and tissue diagnosis before starting antibiotics. Objective of studyOur retrospective study analyses the role of biopsy in establishing the microbiological diagnosis and thus identifying the incidence of pyogenic and tubercular spondylodiscitis presented to a tertiary care centre. Materials and methodsAll patients who were diagnosed as spondylodiscitis by clinical and radiological criteria and who underwent biopsy were included in the study and data was retrieved from medical records and PACS. Criteria for tubercular spondylodiscitis included presence of mycobacterium tuberculosis either in smear/gene Xpert, or histopathological evidence of tuberculosis. Organism isolation other than MTB or absence of tubercular granuloma and response to antibiotics were considered as non-tubercular aetiology. ResultsOur study achieved 84% (n-63) accuracy for first biopsy and 34 patients (53.96%) were diagnosed as pyogenic spondylodiscitis. Organisms were isolated in 11 cases (32%) of pyogenic spondylodiscitis and tubercular bacilli in 17 cases (65%) of tubercular spondylodiscitis. Aspiration of pus yielded better isolation of organisms (P < 0.001) in pyogenic spondylodiscitis. 11% of cases showed drug resistant tuberculosis. ConclusionWe conclude that there is an increasing trend of pyogenous spondylodiscitis compared to tubercular spondylodiscitis in patients presenting to tertiary care centre, hence biopsy is essential to start antimicrobials.

Non-healing Wounds: A Delayed Wound Infection by Mycobacterium Tuberculosis.

Non-healing wound causes significant morbidity and mortality of patients. One of the rare causes behind non-healing wound infection is M. tuberculosis which often remains undiagnosed. The aim of this study was to determine the tuberculosis as one of the causes of non-healing wound. Wounds that did not heal even after secondary suturing and tissue biopsies were sent for histopathological examination. The cases diagnosed with tuberculosis received anti-tubercular treatment. Follow-up was done after 7 and 14days of treatment, and response was seen in terms of reduction in inflammation and discharge. Of the 36 patients, five patients had tubercular infection out of which one patient revealed tubercular granuloma, two revealed epitheloid cells, Langhans cells, whereas two revealed non-specific chronic inflammation in histopathology. A high degree of suspicion and tissue biopsy is required in case of delayed or non-healing wounds to diagnose tuberculosis as a cause. Even if typical tubercular granuloma is not visible in histopathology, the presence of epitheloid cells, giant cells, Langhans cells or predominant lymphocytic infiltrate equally suggests tubercular tissue infection.

Pathomorphological study of atypical pulmonary tuberculosis in cross-bred cow - A case report

Bovine tuberculosis (BTB) is a chronic granulomatous caseous-necrotizing inflammatory process that mainly affects the lungs and their draining lymph nodes. The present communication reports a case of pulmonary tuberculosis in a 7-year-old female crossbred cow from university dairy farm, GADVASU, Ludhiana. The animal died with the history of prolonged illness showing signs of respiratory distress and chronic wasting. The cow was also tested positive previously for tuberculosis by intradermal tuberculin testing. At necropsy, lesions were mostly observed in the pleura, lungs and mediastinal lymph nodes, which were characterized by the circumscribed yellowish white lesions of variable sizes (5 mm to 3 cm) and numbers. Microscopically, these lesions were characterized by tubercular granuloma displaying area of central necrosis with or without mineralization surrounded by macrophages, langhan's giant cells, epithelioid cells, lymphocytes, plasma cells, neutrophils and finally encircled by connective tissue capsule. Atypical granulomas were also noticed particularly in mediastinal lymph node and at times in lungs with extensive infiltration of epithelioid cells and without any caseation, calcification and giant cells. Special stain Ziehl-Neelsen confirmed the acid fast bacilli in the impression smear as well as tissue sections collected from the lesions. On the basis of gross, histopathological observations and special staining, the case was diagnosed as that of atypical pulmonary tuberculosis.

Isolated tubercular granuloma at orbital apex

Isolated tubercular granuloma at the orbital apex is an extremely rare clinical entity which may lead to difficulties in the diagnosis because of the similarities in the presentation to that of a neoplasm. We are presenting a case of 19-year-old male with isolated tubercular lesion at orbital apex. The diagnosis was confirmed by endoscopic biopsy and treated with antitubercular therapy. The diagnosis of isolated tubercular lesion at the orbital apex mainly depends on the clinician having a high index of suspicion. Although it is extremely rare, tuberculosis can be kept in mind and considered as a differential diagnosis of patients presenting with a solitary tumor at orbital apex to avoid unnecessary surgery.