1
|
Kumar MB, Raj S, Vani S, Ravi A, Yadav R, Sethi S. Unmasking the Hidden Invader: A case report of chest wall tuberculosis presenting as an abscess. Indian J Med Microbiol 2024; 49:100600. [PMID: 38685381 DOI: 10.1016/j.ijmmb.2024.100600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/21/2024] [Accepted: 04/27/2024] [Indexed: 05/02/2024]
Abstract
Chest wall tuberculosis is a very rare clinical entity that accounts for 1-5% of musculoskeletal tuberculosis (TB). Here we present a case of chest wall TB. A 16-year-old boy presented with complaints of progressive increasing swelling over the right hemithorax following a history of trauma. Radiologically it was a localized liquid collection with no connection to the thoracic cavity. Pus sample was sent to the mycobacteriology laboratory. The Gene Xpert result came as positive, and sensitive to rifampicin while the acid-fast bacilli (AFB) smear test was negative. Diagnosing a case of chest wall TB is always challenging for clinicians.
Collapse
Affiliation(s)
- Mani Bhushan Kumar
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Stephen Raj
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Sree Vani
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Ashwitha Ravi
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Rakesh Yadav
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Sunil Sethi
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| |
Collapse
|
2
|
Yadav S. Tuberculosis of the Cervical Vertebrae With Retropharyngeal and Parapharyngeal Abscesses Due to Staphylococcus aureus and Mycobacterium tuberculosis in an Adult: A Report of a Rare Case. Cureus 2024; 16:e61412. [PMID: 38953070 PMCID: PMC11215023 DOI: 10.7759/cureus.61412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 07/03/2024] Open
Abstract
Tuberculosis is a disease with presentations both in the lungs and at other extrapulmonary sites. While pulmonary tuberculosis constitutes a significant proportion of total tuberculosis cases, extrapulmonary cases with infections at rare sites are also documented. Herein, an exceedingly rare case of tuberculosis of the cervical vertebrae with retropharyngeal and parapharyngeal abscesses due to Staphylococcus aureus and Mycobacterium tuberculosis in a young Indian male is presented. The rarity of the locations of the lesions with coinfections with two bacteria made the diagnosis challenging. Besides, the potential for a retropharyngeal abscess to compress the airway is an emergency situation. However, the ultimate diagnosis was achieved with the help of a radiograph of the neck, contrast-enhanced computed tomography of the neck, fine-needle aspiration cytology, and a cartridge-based nucleic acid amplification test. He was initiated on appropriate antibiotics and antituberculous chemotherapy per his weight.
Collapse
Affiliation(s)
- Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
| |
Collapse
|
3
|
Chen L, Zhou W, Hu P, Zhou Z. A series of tuberculous cold abscesses at uncommon anatomic sites. Quant Imaging Med Surg 2023; 13:5393-5397. [PMID: 37581047 PMCID: PMC10423395 DOI: 10.21037/qims-22-743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 05/15/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Lei Chen
- Department of Radiology, Minhang Branch, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Wenshen Zhou
- Department of Radiology, Luchun County People’s Hospital of Yunnan Province, Honghe, China
| | - Peian Hu
- Department of Radiology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Zhengrong Zhou
- Department of Radiology, Minhang Branch, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| |
Collapse
|
4
|
Chong W, Loh ST, Kulasegarah J, Loh TL, Tengku Kamalden TMIB. A Timely Burst: Tuberculous Retropharyngeal Abscess. Indian J Otolaryngol Head Neck Surg 2022; 74:1800-1802. [PMID: 36452768 PMCID: PMC9702044 DOI: 10.1007/s12070-020-01809-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 01/22/2020] [Indexed: 11/25/2022] Open
Abstract
Tuberculous retropharyngeal abscess is a rare form of extrapulmonary tuberculosis. We describe an immunocompetent teenager who has her tuberculous retropharyngeal abscess ruptured and then diagnosis confirmed by the presence of acid-fast bacilli from the gastric lavage.
Collapse
Affiliation(s)
- Winton Chong
- Department of Otorhinolaryngology, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Otorhinolaryngology, Head and Neck Surgery, University Malaya Medical Centre, Lembah Pantai, 59100 Kuala Lumpur, Federal Territory of Kuala Lumpur Malaysia
| | - S. T. Loh
- Department of Otorhinolaryngology, Hospital Sultan Ismail, Johor Bahru, Malaysia
| | - J. Kulasegarah
- Department of Otorhinolaryngology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - T. L. Loh
- Department of Otorhinolaryngology, Hospital Sultan Ismail, Johor Bahru, Malaysia
| | | |
Collapse
|
5
|
Xu X, Hu X. Two cases of tuberculous retropharyngeal abscess in adults. J Int Med Res 2021; 49:3000605211011972. [PMID: 33942632 PMCID: PMC8113966 DOI: 10.1177/03000605211011972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Retropharyngeal abscess (RPA) is an acute or chronic deep neck tissue infection. Tuberculous RPA is chronic and extremely rare in adults. A 20-year-old female patient visited the local hospital due to cough and sputum. The sputum smear was positive for acid-fast staining, and lung computed tomography (CT) indicated pulmonary tuberculosis (TB). The patient received the standard regimen of isoniazid+rifampicin+pyrazinamide+ethambutol (HRZE) for 6 months. After HRZE, pulmonary symptoms improved, but some pharyngeal discomfort remained. In another case, a 25-year-old male patient was admitted to our hospital because of a mass on the left side of his neck. Lymph node TB was considered after a puncture biopsy. Lung CT showed no obvious abnormality. After HRZE for 5 months, the mass had progressively enlarged. Both patients underwent B-ultrasonography-guided puncture, and Xpert® MTB/RIF of the abscess was positive and rifampin-sensitive. Tuberculous RPA was diagnosed and treated with isoniazid+rifampicin (HR) for 12 months. After combination anti-TB therapy and surgical drainage, both patients fully recovered. Tuberculous RPA is rare in adults; because of pharyngeal symptoms or progressive enlargement of a neck mass with anti-TB treatment, clinicians need to suspect tuberculous RPA in adults, which is treated with anti-TB therapy and surgery.
Collapse
Affiliation(s)
- Xiaofeng Xu
- Department of Hematology, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Zhejiang Integrated Traditional and Western Medicine Hospital (Hangzhou Red Cross Hospital), Hangzhou, Zhejiang, P.R. China
| | - Xue Hu
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Zhejiang Integrated Traditional and Western Medicine Hospital (Hangzhou Red Cross Hospital), Hangzhou, Zhejiang, P.R. China. Currently working in Hangzhou Occupational Disease Prevention Hospital
| |
Collapse
|
6
|
Huang J, Lei L, Chen B, Pan G, Wang X, Fang M. Remarkable Response of Toripalimab Combined with Chemotherapy in Sarcomatoid Carcinoma of Palatine Tonsil: A Case Report. J Multidiscip Healthc 2021; 14:599-604. [PMID: 33727822 PMCID: PMC7955754 DOI: 10.2147/jmdh.s296584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background Sarcomatoid carcinoma (SaCa) of the palatine tonsil is a rare and aggressive subset of head and neck (H&N) cancer which is characterized by insensitivity to surgery and radiotherapy and a poor prognosis. Immunotherapy has led advances in the treatment of melanoma and H&N cancer, but the combined effects of immunotherapy and chemotherapy have not been sufficiently investigated. Case Presentation Herein, we report the case of 29-year-old Chinese women with local advanced non-resectable SaCa of the palatine tonsil who exhibited a substantial partial response to toripalimab and chemotherapy followed by radiation therapy. To the best of our knowledge, this is the first report of its successful application in this context. Conclusion Toripalimab combined with chemotherapy may be an effective approach for locally advanced H&N cancer in rare categories of patients, which was the first application as far as we know.
Collapse
Affiliation(s)
- Jiahuan Huang
- Department of Breast Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, People's Republic of China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
| | - Lei Lei
- Department of Breast Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, People's Republic of China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
| | - Bo Chen
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China.,Department of Pathology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, People's Republic of China
| | - Guoqiang Pan
- Department of Thoracic Oncology, Wenzhou Medical University, Wenzhou, 325035, People's Republic of China
| | - Xiaojiao Wang
- Department of Breast Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, People's Republic of China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
| | - Meiyu Fang
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China.,Department of Medical Oncology of Rare Cancer and Head and Neck Cancer, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang, 310022, People's Republic of China
| |
Collapse
|
7
|
Salvador GLO, Basso ACN, Barbieri PP, Leitao CA, Teixeira BCA, Neto AC. Central nervous system and spinal cord tuberculosis: Revisiting an important disease. Clin Imaging 2020; 69:158-168. [PMID: 32853843 DOI: 10.1016/j.clinimag.2020.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
Abstract
Tuberculosis is a worldwide pandemic. Estimated that about 25% humans are colonized by Mycobacterium tuberculosis and about 1% are believed to develop the infection in the central nervous system (CNS-TB). Given the importance of this disease and its high levels of morbidity and mortality, it is imperative that every radiologist must be reminded of the most common findings of CNS-TB as there are several related differential diagnoses for this disease. The most common form CNS-TB is tuberculous meningitis (TBM), characterized mostly by basal meningitis, but infarction, hydrocephalus and tuberculomas could be present. Intracerebral tuberculosis is characterized by tuberculomas that can have different imaging features according to their stage. Vascular and spinal complications of tuberculosis are also reported. This review compiles the classic and unusual findings regarding CNS-TB together with new diagnostic scores in which neuroimaging have an important role.
Collapse
Affiliation(s)
- Gabriel L O Salvador
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil.
| | - Ana C N Basso
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
| | - Poliana P Barbieri
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
| | - Cleverson A Leitao
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
| | - Bernardo C A Teixeira
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
| | - Arnolfo C Neto
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
| |
Collapse
|
8
|
Rosales-Castillo A, Javier-Martínez MR, López-Ruz MÁ. Chest wall tuberculosis: a rare extrapulmonary localization. Med Clin (Barc) 2020; 157:42. [PMID: 32693922 DOI: 10.1016/j.medcli.2020.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | | | - Miguel Ángel López-Ruz
- Servicio de Medicina Interna. Hospital Universitario Virgen de las Nieves, Granada, España
| |
Collapse
|
9
|
Kosmidou P, Kosmidou A, Angelis S, Dimitriadou PP, Filippou D. Atypical Retropharyngeal Abscess of Tuberculosis: Diagnostic Reasoning, Management, and Treatment. Cureus 2020; 12:e9124. [PMID: 32789065 PMCID: PMC7417134 DOI: 10.7759/cureus.9124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Retropharyngeal abscess caused by tuberculosis (TB) is an unusual life-threatening disease. We present the case of a patient, mainly complaining about dysphagia, cephalalgia, and neck pain. History, examination, and laboratory data were inconclusive. Diagnostic imaging revealed retropharyngeal abscess with atypical characteristics. Aspiration through the pharynx was performed. The aspirated fluid sent for microscopic examination by polymerase chain reaction (PCR) gene probe, revealed Mycobacterium tuberculosis (MTB). Subsequently, the patient was treated with a standard nine-month anti-TB chemotherapy. The combination of fine-needle aspiration and antitubercular agents was successful. The aim of the present study is to inform the importance of early diagnosis with targeted therapy.
Collapse
Affiliation(s)
- Panagiota Kosmidou
- Otolaryngology - Head and Neck Surgery, General Hospital of Thoracic Diseases, Athens, GRC.,Otolaryngology, Audiology-Neurotology, School of Medicine, University of Patras, Patras, GRC
| | | | - Stavros Angelis
- Surgical Anatomy, National and Kapodistrian University of Athens Medical School, Athens, GRC.,Orthopaedics, Panagiotis and Aglaia Kyriakou Children's Hospital, Athens, GRC.,Orthopaedics, General Hospital Hellenic Red Cross "Korgialenio-Benakio", Athens, GRC
| | - Paraskevi P Dimitriadou
- Language, Literature and Civilization of the Black Sea Countries, Democritus University of Thrace, Komotini, GRC
| | - Dimitrios Filippou
- Surgery, National and Kapodistrian University of Athens Medical School, Athens, GRC
| |
Collapse
|
10
|
Gao W, Zeng Y, Chen W. Multiple subcutaneous tuberculous abscesses in a dermatomyositis patient without pulmonary tuberculosis: a case report and literature review. BMC Infect Dis 2020; 20:409. [PMID: 32532200 PMCID: PMC7291664 DOI: 10.1186/s12879-020-05137-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/04/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Even though remarkable progress for diagnostics of pulmonary TB has been made, it is still a challenge to establish a definitive diagnosis for extrapulmonary TB (EPTB) in clinical practice. Among all the presentations of EPTB, cold abscesses are unusual and deceptive, which are often reported in the chest wall and spine. Subcutaneous abscess in the connective tissue of limbs is extremely rare. CASE PRESENTATION A 48-year-old man with dermatomyositis was hospitalized because of multiple subcutaneous tuberculous abscesses in his limbs, but without pulmonary tuberculosis. Particularly, one insidious abscess appeared during anti-TB treatment due to "paradoxical reaction". After routine anti-TB therapy, local puncture drainage and surgical resection, the patient was cured and discharged. CONCLUSIONS Tuberculous infection should be kept in mind for the subcutaneous abscess of immunocompromised patients, even without previous TB history. Treatment strategy depends on the suppurating progress of abscess lesions. Meanwhile, complication of newly-developed insidious abscess during treatment should be vigilant.
Collapse
Affiliation(s)
- Weiwei Gao
- Department of Tuberculosis, the second hospital of Nanjing, Nanjing University of Chinese Medicine, 1-1 Zhongfu Road, Gulou district, Nanjing, 210003 Jiangsu province China
| | - Yi Zeng
- Department of Tuberculosis, the second hospital of Nanjing, Nanjing University of Chinese Medicine, 1-1 Zhongfu Road, Gulou district, Nanjing, 210003 Jiangsu province China
| | - Wei Chen
- Clinical Research Center, the second hospital of Nanjing, Nanjing University of Chinese Medicine, 1-1 Zhongfu Road, Gulou district, Nanjing, 210003 Jiangsu province China
| |
Collapse
|
11
|
Thomas K, Gupta M, Gaba S, Gupta M. Tubercular Retropharyngeal Abscess With Pott's Disease in an Elderly Male Patient. Cureus 2020; 12:e8256. [PMID: 32596074 PMCID: PMC7313433 DOI: 10.7759/cureus.8256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Retropharyngeal abscess (RPA) is a life-threatening emergency due to its potential to cause airway compression. It is rare in the elderly and occurs mostly in immunocompromised patients, or as a complication of instrumentation. We are reporting the case of a 70-year-old male who presented with sudden onset breathing difficulty with a history of dysphagia for three months. The clinical examination revealed a bulge in the posterior pharyngeal wall. A lateral-view radiograph of neck revealed retropharyngeal soft tissue density with carious spine. The patient was successfully treated by trans-oral incision and drainage of the abscess under local anesthesia. Diagnosis of tuberculosis was confirmed by positive acid-fast staining and cartridge-based nucleic acid amplification test (CBNAAT). The patient improved significantly following the initiation of anti-tubercular therapy.
Collapse
Affiliation(s)
- Kiren Thomas
- Otolaryngology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, IND
| | - Manish Gupta
- Otorhinolaryngology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, IND
| | - Saurabh Gaba
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Monica Gupta
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
| |
Collapse
|