Hemorrhagic pleural effusion in Indonesian male with pulmonary tuberculosis: A rare case

Partial adhesive small bowel obstruction due to peritoneal tuberculosis HIV/AIDS patient: A case report

INTRODUCTION

Diagnosing peritoneal tuberculosis is challenging due to unspecific clinical manifestations, particularly in immunocompromised patients with HIV/AIDS and tuberculosis infections.

PRESENTATION OF CASE

An Indonesian man, 26-years-old, complained of mid-abdominal colic and constipation. The patient's present state exhibited symptoms of weakness and paleness, oral candidiasis, a bloated abdomen, palpable discomfort, and shifting dullness. The ascitic fluid analysis showed increased ADA (709 U/L), and detected Mycobacterium tuberculosis using GeneXpert MTB/RIF. Radiographic examination from abdominal x-ray and CT scan revealed a small bowel obstruction. He received intestinal decompression, pain control, intravenous fluid resuscitation, and correction of electrolyte imbalance for small bowel obstruction without any indication for surgical intervention. He also receive first-line ATD for 2 months during intensive phase and 4 months for continuous phase. After a period of 2 weeks following the ATD administration, the patient began taking ARV medication on a daily basis. He showed a good prognosis 6 months following.

DISCUSSION

The diagnosis of peritoneal tuberculosis is challenging due to its unspecific manifestation and some cases are identified when complications such as small bowel obstruction appear. The ADA test and GenExpert MTB/RIF are useful instruments for promptly diagnosing tuberculosis. It is suggested to use ARV treatment in individuals with HIV/AIDS who have peritoneal tuberculosis, starting 2 weeks following ATD treatments.

CONCLUSION

Peritoneal tuberculosis with small bowel obstruction and HIV/AIDS infection is a rare case in which early diagnosis and monitoring play an important role in successful treatment.

Tuberculous pleuritis: clinical presentations and diagnostic challenges

PURPOSE OF REVIEW

Tuberculous pleuritis (TBP) is one of the most common types of extrapulmonary tuberculosis. We highlight the latest epidemiology of TBP, the heterogeneity of its presentation and the performance of different diagnostic strategies.

RECENT FINDINGS

There are differential trends in the incidences of TBP worldwide. Its incidence increased in China but decreased in the United States in the past decade. The presentation of TBP is heterogeneous regarding clinical symptoms, radiological findings and pleural fluid analysis results. Conventional microbiological tests have low sensitivities to diagnose TBP. Recent research focused on various diagnostic tools with better yield. The sensitivity of nucleic acid amplification tests (NAAT) in pleural fluid, including the latest generation of PCR and sequencing-based techniques for detecting tuberculosis, remains suboptimal. Various pleural fluid biomarkers have been explored, but there is a lack of consensus on their clinical utility and cutoff levels.

SUMMARY

The heterogeneity of clinical presentation poses obstacles to diagnosing TBP. Further development of diagnostic tools, including more robust NAAT and biomarkers with additional validation, is needed before incorporation into routine clinical practice.

Bilateral spontaneous pneumothorax in tuberculosis and HIV patient: A case report

INTRODUCTION

Bilateral secondary spontaneous pneumothorax due to tuberculosis and human immunodeficiency virus (TB-HIV) infection is a rare case which has a poor prognosis and high-risk mortality.

CASE PRESENTATION

An Indonesian male, 31 years old, complained of shortness of breath, chest pain, and weight loss (15 kg for 2 months). He has a history of HIV and has been only on ARVs for 3 months since being diagnosed. He, his sister, and his mother had all experienced tuberculous lymphadenitis. The patient appears weak, dyspnea, visual analogue scale (VAS) of 5, blood pressure (BP) of 92/64 mmHg, heart rate (HR) of 112 ×/min, temperature of 37.7 °C, respiratory rate (RR) of 32 ×/min, oxygen saturation (SpO2) of 98 % (simple mask of 8 L/min). On inspection and fremitus, the development of left lung expansion was delayed. Percussion sound of left lung was hypersonor and decreased lung sounds on auscultation. A chest X-ray revealed pneumothorax sinistra. The patient underwent needle thoracocentesis with chest tube insertion and water seal drainage (WSD). During the continuation phase, the patient also took anti-retroviral (ARV) and anti-tuberculosis drug (ATD). The patient had improved but a few days later developed a pneumothorax dextra and received treatment. The patient only survived for 2 days afterwards and died caused by hypovolemic shock.

DISCUSSION

Management of pneumothorax in TB-HIV patients shows only temporary improvement but poor prognosis. Adherence of HIV patients to ARVs minimizes the risk of infected with Mycobacterium tuberculosis in endemic areas.

CONCLUSION

HIV patients are anticipated to remain committed to their treatment regimens in order to reduce the occurrence of pneumothorax induced by TB-HIV in endemic areas.

An Indonesian female with peritoneal tuberculosis mimicking ovarium carcinoma: A rare case

INTRODUCTION

Peritoneal tuberculosis is rare when patients with abdominal pain need to be considered for tuberculosis testing.

CASE PRESENTATION

An Indonesian female, 19 years old, complained of abdominal pain and enlargement. Laboratory examination is abnormal, including thrombocytosis of 687,000/uL and Ca-125 of 3483 U/mL. Ultrasound and CT scan of the abdomen showed cystic lesions in the pelvic cavity, enlargement of the abdominal lymph nodes, and ascites. She was diagnosed with ovarian carcinoma. The patient underwent surgery and obtained nodules such as tuberculoma. Nodule biopsy results showed granulomatous inflammation. The patient was given anti-tuberculosis drug (ATD) category 1 for 2 months and continued with category 2 for 7 months (total 9 months of treatment). The prognosis showed improvement, and weight increased by 15 kg (from 40 kg to 55 kg).

DISCUSSION

The challenge of peritoneal tuberculosis is the absence of specific signs and symptoms. Therefore, tuberculosis testing must be considered if tuberculosis is endemic in patients with abdominal pain who do not show a good prognosis when treated according to the developed signs and symptoms.

CONCLUSION

Suspicion of tuberculosis infection should be evaluated in endemic tuberculosis because some tuberculosis infections, such as peritoneal tuberculosis, do not have specific signs and symptoms.

Chest wall tumor tuberculosis in Indonesian adolescent: A rare case

Background

Extrapulmonary tuberculosis has increased in the last few decades, and establishing a diagnosis is still challenging.

Case presentation

A 15 years old Indonesian adolescent complained of a lump on the right lung. The patient and his mother had a history of pulmonary tuberculosis and received the anti-tuberculosis drug. Chest inspection showed a soft consistency mass, smooth surface, poorly defined borders, and size of 7 × 7 cm in the posterolateral dextra region. Radiological examination showed a mass of 2 × 2.5 × 5.3 cm in the right anterior mediastinum. FNAB lymph nodes showed granulomatous inflammation consistent with tuberculosis. The patient had a wide excision tumor, and a GeneXpert MTB/RIF examination of the tumor excision material showed that Mycobacterium tuberculosis was detected very low. The patient received an anti-tuberculosis drug and had a good prognosis.

Discussion

Patients with a family history of tuberculosis should be examined for tuberculosis. Although in a patient with lung carcinoma signs and symptoms, it does not rule out chest wall tuberculosis.

Conclusion

Enforcement of the correct diagnosis can increase the prognosis of extrapulmonary tuberculosis.

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GeneXpert MTB/RIF examination should be performed on patients with a family history of tuberculosis.

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Management of Chest wall tuberculosis included incision and anti-tuberculosis drugs.

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Extrapulmonary tuberculosis does not have non-specific signs and symptoms.

Anti-tuberculosis drug-induced liver injury in patient with hepatitis B and cirrhosis: A case report

Background

Pulmonary tuberculosis patients infected with hepatitis B are at high risk for drug-induced liver injury.

Case presentation

A 42-year-old Indonesian female complained of sclera icterus, tea-colored urine, vomiting, dyspnea, and swollen stomach and legs. The patient experienced this condition after taking anti-tuberculosis drugs for five days. Her medical history showed hepatitis B and cirrhosis. Follow-up examination included chest X-ray and GeneXpert supported a diagnosis of pulmonary tuberculosis. However, abdominal ultrasonography indicated ascites and cirrhosis. We diagnosed the patient with anti-tuberculosis DILI, cirrhosis Child-Pugh C (score 12) related to hepatitis B, and pulmonary tuberculosis. We decided to stop the anti-tuberculosis drug. We treated the patient using tenofovir, hepatoprotective drug, diuretics, and albumin infusion. On the third day, the patient received new anti-tuberculosis drugs, including levofloxacin 750 mg, ethambutol 1000 mg, and streptomycin 1000 mg (LES). The patient's condition then gradually improved.

Discussion

The dilemma of treating tuberculosis in liver disease is treating tuberculosis without ignoring hepatitis B and cirrhosis.

Conclusion

Administration of anti-tuberculosis drugs based on liver tolerance of hepatotoxic drug in patients with hepatitis B and cirrhosis.

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Cirrhosis and Hepatitis B are risk factors for anti-tuberculosis DILI.

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The priority of DILI management is stopping anti-tuberculosis drugs.

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Anti-tuberculosis DILI is treated based on the Child-Pugh category.