Unusual Presentation Of Tuberculosis Research Articles

Unusual presentations of tuberculosis: A diagnostic challenge

Unusual presentations of tuberculosis: A diagnostic challenge

Unusual Presentation of Tuberculosis in Head and Neck: A Case Report

Unusual Presentation of Tuberculosis in Head and Neck: A Case Report

Isolated Tuberculous Epididymitis: A Case Report and Review of the Literature

In 2021, tuberculosis remains a world health problem. It is still the first cause of mortality by infectious disease in the world [1]. Fortunately, in developed countries, tuberculosis is a very rare pathology. Genitourinary tuberculosis has been reported to account for 20% to 73% of all cases of extrapulmonary tuberculosis in the general population [2]. The epididymal involvement accounts for only about 20% of the genitourinary tuberculosis [3]. Isolated genitourinary tuberculosis (GUTB) is a rare and unusual presentation of tuberculosis that occurs in young male or female adults and that can cause infertility [4]. Most of the time, infertility is due to the inflammation and scarring that follow the infection, resulting in distortion of the normal anatomy and causing obstruction of the excretory tract [5]. The disease typically develops slowly. Early diagnosis is difficult, therefore delayed diagnosis and misdiagnosis are common [6].

An Unusual Presentation of Tuberculosis at Atypical Anatomical Location: Rectus Abdominis Muscle

Unusual presentation of Tuberculosis (TB) in anatomical locations like skeletal muscle which are atypical and not favorable for survival and multiplication of Mycobacterium tuberculosis.Commonly, muscle involvement is secondary. A direct inoculation (abdominal lymph node) or extension from underlying tubercular synovitis and osteomyelitis may involve an abdominal muscle. The case report is about a 43-year-old female who presented with an abdominal lump for past one month. There was no history of cough, weight loss, pain abdomen, recurrent vomiting, breathlessness and no history of TB or close contact with TB patient. Ultrasound (USG) and Contrast Enhanced Computed Tomography (CECT) of the abdomen revealed loculated collection in right rectusabdominis muscle, and USG-guided aspiration for cytology, culture and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) confirmed tubercular abscess. The patient was managed as per National Tuberculosis Elimination Programme and responded well with antitubercular drug therapy for six months. This case throws light on to the possibility of tubercular infection in atypical anatomical locations as primary foci, especially in those areas where tuberculosis is endemic.

Endobronchial Tuberculosis Simulating Acute Foreign Body Inhalation: A Case Report.

Endobronchial tuberculosis is a rare form of pulmonary tuberculosis, that can be due to the rupture of an infected lymph node through bronchial wall or lymphatic spread to the lining of the bronchial tree. Clinical presentation is non-specific, and can simulate inhalation of a foreign body. Otolaryngologists should be aware of its presentation often atypical. The following case is an unusual presentation of endobronchial tuberculosis in a 23-month-old patient initially diagnosed as a foreign body in the respiratory tract with acute dyspnea with unilateral wheezing and suspected foreign body on chest computed tomography. Bronchoscopy revealed a granulomatous mass in carina and both primary bronchi. Granuloma ablation improved patient's respiratory status. The pathology revealed an epithelioid and gigantic cellular with caseous necrosis compatible with tuberculosis. This unusual presentation of tuberculosis should be known to otolaryngologists and pediatricians in view of the frequency of tuberculosis in our context as well as increase in its incidence.

Chronic tenosynovitis of the hand – an unusual presentation of tuberculosis in children

Tuberculosis remains the most common cause of death from infectious diseases worldwide. Extrapulmonary tuberculosis with musculoskeletal involvement occurs in about 10-15% of cases, mainly affecting joints and bones. Of these, only 1-5% are reported as synovitis of the hand. However, prompt diagnosis and treatment are often delayed and, if left untreated, bone and tendon destruction soon ensue and may lead to chronic synovitis. A 15-year-old girl presented with recurrent pain of the hand following trauma. Imaging showed tenosynovitis and tendon rupture. Surgical treatment was performed. Pathological assessment revealed necrotic caseous granulomas. Chest radiography showed no abnormal findings, but both Tuberculin Skin Test and Interferon Gamma-Release Assay were positive. Tuberculous tenosynovitis was diagnosed, and 12-month anti-tuberculous chemotherapy was instated. Five years after surgery, the patient maintained chronic pain and functional hand limitation.Tuberculous tenosynovitis of the hand is a rare and insidious condition that should be considered in the differential diagnosis of chronic hand pain. Delayed diagnosis and treatment can lead to residual functional limitation, making disease recognition critical.

DIFFERENT PRESENTATION OF TUBERCULOUS ORCHITIS: CASE SERIES

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Extrapulmonary tuberculosis (TB) still presents a diagnostic and therapeutic challenge. Genitourinary TB constitutes about 20% of the extrapulmonary cases in regions where TB is endemic. Where TB is found in unexpected sites, its positive diagnosis remains important. Tuberculous infection of epididymis and testis is difficult to differentiate clinically from pyogenic infection, tumour or infarction. The clinical presentation of genitourinary tuberculosis (TB) may be variable and a high index of suspicion is required for a timely diagnosis, especially in endemic areas. Scrotal ulcers associated with epididymo-orchitis should alert the clinician of a possible diagnosis of TB. Isolated tuberculous epididymo-orchitis may closely mimic testicular tumour particularly in patients with no history of systemic TB thereby presenting a diagnostic and treatment challenges. CASE PRESENTATION: Case1: 49 years old immunocompetent male smoker came with swelling and pus discharging ulcer in right testis for 3 months. Genital examination showed ulcer over posterior aspect and sinus over anterior aspect of the enlarged scrotum. His chest x ray was normal. USG scrotum echogenic collection with specks of calcification in TV sac. Sinus tract was excised and CBNAAT shows rifa sensitive MTB. Case2: 55 years old immunocompetent male, never smoker came with dry cough, right sided scrotal pain with pus discharging ulcer of 20 days duration. He denied prior ATT, and had no contact with tuberculosis. USG scrotum showed anechoeic collection in right TV sac. CXR showed air space opacity on right upper zone. Sputum: AFB 1+ , CBNAAT: rifa sensitive, MTB detected low. Discharge from ulcer in CBNAAT showed rifa sensitive MTB. Case3: 28 years old immunocompetent male had scrotal swelling of 6 months duration. No constitutional symptoms. Had prior ATT taken only 3 months for HPE proved TB right cervical adenitis. Genital examination showed sinus tract in posterior aspect of right scrotum. USG scrotum shows scrotal wall abscess suggestive of tuberculosis. Sinus tract excision has epitheloid granuloma without caseous necrosis and CBNAAT had rifa sensitive MTB. All 3 cases showed free from symptoms and partial resolution of ulcer after 2 months of ATT. DISCUSSION: Tuberculous epididymitis may be the presenting symptom of genitourinary TB. It usually presents as a painful, inflamed scrotal swelling but occasionally can present as a draining sinus on the posterior surface of the scrotum. TB orchitis without epididymal involvement is very rare. It is most common in young (20-40 years), sexually active males but here in middle age group also involved. CONCLUSIONS: The clinical presentation of genitourinary tuberculosis (TB) may be variable and a high index of suspicion is required for a timely diagnosis, especially in endemic areas. Sebaceous cyst is the commonest swelling that occurs in the scrotal skin. Reference #1: AlZayyani, N. R., Wani, A. M., Al Miamini, W. & Al Harbi, Z. S. Chronic epididymo-orchitis and scrotal ulcers. BMJ Case Rep. (2011) doi:10.1136/bcr.03.2010.2825. Reference #2: Shenoy, V. P., Viswanath, S., D’Souza, A., Bairy, I. & Thomas, J. Isolated tuberculous epididymo-orchitis: An unusual presentation of tuberculosis. J. Infect. Dev. Ctries. (2012) doi:10.3855/jidc.2145. Reference #3: Khan, A., Singaraddi, R., Shetty, D. & Rodrigues, G. Primary cutaneous ‘ulcerative’ tuberculosis of the scrotum: A rare occurrence. BMJ Case Rep. (2018) doi:10.1136/bcr-2018-227177. DISCLOSURES: No relevant relationships by UMAPATHI SIVASUBRAMANIAM, source=Web Response

An unique case report: Unusual presentation of mediastinal lymph node tuberculosis in an adult

Tuberculosis (TB) is a serious public health problem in Bangladesh. National tuberculosis control program recognizes that almost half of the TB cases remain undiagnosed in the country. To increase case detection rate, it is very important to familiarize the physicians with unusual presentation of TB. We describe a 51 years old woman with a past medical history of Hypertension (HTN), Type 2 Diabetes Mellitus (DM), and Nonalcoholic steatohepatitis-chronic liver disease (NASH-CLD) who presented to us with low grade fever, anorexia, nausea, and recurrent vomiting for one month. Physical examination and laboratory tests revealed no significant abnormalities and symptoms were treated symptomatically. After about two months, the condition did not improve. All routine blood biochemistry and imaging reports were not suggestive of any disease except for high ESR and abnormal LFT (mild increase in ALP, ALT and moderate increase in GGTP). To exclude the differential diagnoses (such as abdominal TB), we advised computed tomography (CT) scan of chest and abdomen but the results came out normal. Her PPD came out positive but it was not confirmatory of TB as the patient was previously vaccinated with BCG vaccine. As the patient was immune-compromised we suggested starting Anti-TB drugs based on clinical judgment and in the context of Bangladesh being a TB endemic area. But the patient was not convinced to take anti-Tb drugs without definite diagnosis. After another month of persistent symptoms a repeat CT of the chest was advised that revealed multiple enlarged mediastinal lymph-nodes. As the patient had a history of CLD and high PT, Fine Needle Aspiration Cytology (FNAC) was deferred. Patient was started on Anti tubercular treatment and symptoms subsided within three weeks. Treatment was continued for one year. This case summarizes the unusual presentation of mediastinal lymph node Tuberculosis in an adult.

Chylothorax with Transudate: An Unusual Presentation of Tuberculosis.

IntroductionTwenty-five per cent of tuberculosis patients have pleural tuberculosis, which is the third most common form of presentation. Most cases present as an exudative pleural effusion with just few cases reported as chylothorax in the literature. All pleural effusions from confirmed cases, including tuberculous chylothorax, had exudate features.AimTo describe a patient with Mycobacterium tuberculosis affecting the lungs and pleura, which laboratory testing demonstrated had features of transudate chylothorax.Patient and methodsA 70-year-old man presented with constitutional symptoms, progressive exertional dyspnoea and right pleural effusion with fibrocavitary changes on chest imaging. Thoracentesis and pleural fluid analysis revealed chylous fluid with transudate features, high triglycerides, low cholesterol content and mononuclear cell predominance. Acid-fast sputum stains and pleural fluid were negative for Mycobacterium tuberculosis as was an adenosine deaminase test for pleural effusion. Tomography-directed lung biopsy sampling of a lung nodule revealed a chronic granulomatous inflammatory process associated with the presence of acid-fast bacilli.DiscussionTuberculosis-associated chylothorax is an uncommon presentation of the disease. A recent review found only 37 cases of confirmed tuberculous chylothorax had been reported in the literature. All cases had exudate characteristics. The diagnosis of pleural tuberculosis was made through culture or testing of sputum, pleural fluid or biopsy samples in 72.2% of cases, with the rest identified by histopathology.LEARNING POINTSThe main cause of non-traumatic chylothorax is malignancy, which is found in 39–72% of cases.Few cases of transudative chylothorax have been reported in the literature; the main aetiology is chronic hepatopathy.Tuberculosis-associated chylothorax is a rare presentation of infection caused by Mycobacterium tuberculosis, an uncommon aetiology.

An Unusual Presentation of Tuberculosis

The normal pericardium is a fibroelastic sac containing a thin layer of fluid that surrounds the heart. Cardiac tamponade, which may be acute or subacute, is characterized by the accumulation of pericardial fluid under pressure. Tuberculous pericarditis is a complication of tuberculosis which is often diagnose late due to the difficulty in establishing this diagnosis. We present a case of pericardial tuberculosis diagnosed in a 20-year-old young retroviral disease patient who presented with signs of cardiac tamponade. His clinical condition improved post-pericardial tapping and he was discharged with antituberculosis medications. This case highlight the importance of having a high level of suspicion as this condition is easily curable.

Multifocal skeletal tuberculosis with atypical imaging features

Multifocal skeletal involvement is exceptional, constituting <5% of all bony tuberculosis (TB), even in countries where TB is endemic. Multifocal skeletal TB is defined as osteoarticular lesions that occur simultaneously at two or more locations. We describe an immunocompetent patient with multifocal skeletal TB involving multiple vertebrae, ribs, and pelvis with empyema necessitans who also had atypical imaging features to make the readers aware of such unusual presentations of TB.

Severe thrombocytopenia and intracranial hemorrhage: Unusual presentation of tuberculosis

BackgroundAlthough various hematologic abnormalities are seen in tuberculosis (TB), severe thrombocytopenia is a rare event.Case presentationWe report a case of a 26-year-old female patient who presented with severe thrombocytopenia-induced hemoptysis, macroscopic hematuria, and intracranial hemorrhage. The patient was found to have clinical, microbiological, and histopathological evidence of TB. The thrombocytopenia was successfully treated with anti-TB drugs.ConclusionSevere thrombocytopenia can be one of the hematological manifestations of TB that is successfully treated with anti-TB drugs.

Tuberculous aortitis, an unusual presentation of tuberculosis

51-year-old female who recently emigrated from Mexico with past history of coronary artery disease (CAD) status post coronary artery bypass grafting (CABG) two years prior who presented with chest pain. She reported diffuse anterior chest pain that radiated to the back. She also reported a 4 kg weight loss, night sweats, chills and fevers over the same time period. In the emergency department her EKG was normal, cardiac enzymes were negative and preliminary CTA report was concerning for possible aortitis vs aortic hematoma. Her ESR and CRP were elevated but autoimmune work-up including ANCA and ANA was negative, raising suspicion for an underlying infectious etiology. The patient had a positive PPD skin test with 17 mm induration, a positive quantiferon test and chest X-ray showed numerous lung nodules bilaterally, consistent with a diagnosis of tuberculosis. Transesophageal echocardiogram showed regional thickening of ascending aorta with the major differential being aortitis vs intramural hematoma vs chronic aortic dissection. Her records from her CABG done in Mexico were obtained and described a porcelain aorta, which further supported a diagnosis of TB aortitis. Cardiothoracic surgery was consulted in light of these results, and they believed that the patient’s aortic thickening was caused by diffuse aortitis. Thus she was diagnosed with aortitis secondary to her underlying tuberculosis. Most cases of aortitis are noninfectious in nature. However, although rare, infectious causes should always be considered due to associated high morbidity and mortality as well as potential reversibility. Tuberculosis as a cause of aortitis is very rare even in developing countries. Tuberculous aortitis should always be considered among patients with aortitis or aortic hematomas, especially if they are among high risk population for tuberculosis or have a history of untreated tuberculosis.

Bilateral Tubercular Dactylitis: Unusual presentation of an usual disease

IntroductionBilateral Tubercular Dactylitis (TD) is an unusual presentation of tuberculosis and only handful numbers of cases are reported in the literature. Hence, very little is known about its clinical presentation, statistic, radiological features and its outcome. MethodsWe have included seven male and two female patients of mean age 7.2 years, of the proven cases of bilateral TD by histopathological or microbiological or PCR analysis from core biopsy. Radiological features were recorded from plain radiograph. All patients were given Antitubercular drugs according to WHO 2010 recommendation (four drugs for 3–5 months, three drugs for next 3–5 months and finally two drugs for 6–8 months). Debridement was done whenever required. ResultsOf total 26 lesions, the most common presentation was swelling with or without mild pain. Discharging sinus was present in four lesions. There were six phalanges, 18 metacarpal and two metatarsals. Radiographically, the most common type of lesion was soft tissue swelling followed by lytic lesion. Histopathologically tuberculosis was proven in 10 (55.6%) lesions, bacteria isolated in 5 (27.8%) lesions and PCR was done in 8 lesions and was positive in all. All lesions healed after giving ATT except one which developed psudo-arthrosis and one patient developed coronal plane deformity that was corrected by JESS. ConclusionA clinician should always suspect tuberculosis while dealing with a pathology of hand and feet even if it is bilateral. Suspected case can be diagnosed by histopathological, microbiological or PCR analysis and it can be treated by ATT with a good functional outcome.

Unusual presentations of tuberculosis – A case series

Tuberculosis (TB) is commonly found in developing countries. Lung is predominantly affected while extra pulmonary tuberculosis (EPTB) is rarely encountered. The clinical features of EPTB can be non-specific that mimics other diseases and is usually misdiagnosed. Thus, it is very important to be aware and be highly suspicious of EPTB infection especially in endemic area. We share 3 cases of different uncommon presentations of head and neck TB, which involved larynx, parotid salivary gland and cervical lymph node. The diagnosis was made by histopathological examination and positive Acid Fast Bacilli (AFB) smears. They were successfully treated with anti-tuberculosis treatment.

Development and Validation of the COMPLES Score for Differentiating Between Tuberculous Effusions with Low Pleural pH or Glucose and Complicated Parapneumonic Effusions.

The frequency of "complicated" pleural effusions (CPE) (i.e., pleural fluid pH≤7.2 and/or glucose ≤60mg/dL) of tuberculous origin (CTPE) is not well reported. This study aims to quantify their prevalence, and develop a score to differentiate CTPE from complicated parapneumonic effusions (CPPE). Retrospective analysis of databases from three Spanish hospitals which included patients with CTPE and CPPE. Forty percent of the study population served to generate a scoring system (COMPLES, COMplicated PLeural Effusion Score) that was further validated in the remaining 60%. During the study period (1992-2015) 549 patients were diagnosed with tuberculous effusions and 434 parapneumonic effusions, of whom 25 and 64%, respectively, had CPE. COMPLES was based on the combination of pleural fluid adenosine deaminase (ADA), the percentage of mononuclear cells (MNC%), pH, and age. The cutoff values and assigned scores were: ADA (<46IU/L [0 points], 46-100IU/L [4 points], ≥100IU/L [6 points]), MNC% (<10% [0 points], 10-50 [3 points], >50 [8 points]), pH (<7.07 [0 points], 7.07-7.20 [3 points], >7.20 [5 points]), and age (≥30 [0 points], <30years [3 points]). A sum of 12 or more points had 97% sensitivity, 92% specificity, likelihood ratio positive 12.3, likelihood ratio negative 0.03, and area under the curve of 0.947 for identifying CTPE versus CPPE in the validation set. CPE is not an unusual presentation of tuberculosis. A simple new scoring system provides a reliable tool for differentiating between CTPE and CPPE.

Unusual Presentations of Tuberculosis: A Case Series

Introduction: Tuberculosis (TB) is an air-borne infection caused by the organism Mycobacterium Tuberculosis that can affect any organ though it commonly involves infection of the lungs. Given the nature of Extra-Pulmonary Tuberculosis (EPTB) that has vario...

Some rarer manifestations of tuberculosis

In this report we present four cases of unusual presentation of tuberculosis, one presenting as tubercular affection of thyroid, one as leukemoid reaction, one as peripheral neuropathy and one as thrombocytopenia followed by a hypercoagulable state leading to DVT.In a country like India where is incidence of tuberculosis is high, one should keep such unusual presentations of tuberculosis in mind while addressing the differential diagnosis of the case.

Tuberculous Gastric Abscess in a Patient with AIDS: A Rare Presentation

Tuberculosis is a healthcare concern that affects millions of individuals around the globe. Coinfection with HIV has changed both the clinical presentation and the outcome of the disease dramatically in the last few decades. Extrapulmonary tuberculosis is seen more frequently in the immunocompromised host. An unusual case of gastric tuberculosis in an AIDS patient is reported here. A 49-year-old female with AIDS was admitted for fever and epigastric pain. A gastric submucosal abscess was observed on imaging and confirmed by biopsy showing numerous neutrophils and acid-fast bacilli. Aspirate grew Mycobacterium tuberculosis. This report highlights a very unusual presentation of tuberculosis in an immunodeficient patient. High clinical suspicion for opportunistic infections in unusual locations should be maintained in these patients presenting with clinical syndromes that do not respond to standard treatments. New diagnostic modalities facilitate accurate identification of these infections.

A CASE OF DISSEMINATED TUBERCULOSIS WITH OCULAR INVOLVEMENT

AbstractDisseminated Tuberculosis (DTB) refers to tubercular involvement of two or more non-contiguous sites and is commonly associated with immunocompromised state. It is an unusual presentation of Tuberculosis (TB), especially in the absence of immunodeficiency. 1.4% of patients with Pulmonary Tuberculosis (PTB) develop ocular manifestations but many patients with ocular TB have no evidence of PTB. Tuberculosis can cause a wide variety of ophthalmic findings, ranging from the ocular surface through the optic nerve and to the central nervous system. In this article, we report a case of Disseminated Tuberculosis with ocular involvement in a 5years old female. Our case is unique for the presence of bilateral squint, unilateral nebular type of corneal opacity, bilateral iritis with posterior synechiae and cataract at the same time. It lays emphasis on the fact that a patient with tuberculosis should be screened for multiple foci.