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Lino R, Amorim S, Silva C, Neves N, Araújo P, Pinto R, Pinheiro-Torres J, Pinho P, Macedo F, Santos L. Cutaneous Tuberculosis in Heart Transplant. Transplant Proc 2023; 55:1444-1448. [PMID: 37142508 DOI: 10.1016/j.transproceed.2023.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/06/2023] [Accepted: 03/27/2023] [Indexed: 05/06/2023]
Abstract
Tuberculosis is a disease with a significant global burden in terms of morbidity and mortality. It usually presents as a pulmonary disease but can occasionally have extrapulmonary presentations. Immunosuppressed people are at an increased risk of tuberculosis and more frequently have atypical manifestations of the disease. Cutaneous involvement is estimated to occur in only 2% of extrapulmonary presentations. We report a case of a heart transplant recipient with disseminated tuberculosis who initially presented with cutaneous manifestations in the form of multiple abscesses that were mistaken for a community-acquired bacterial infection. The diagnosis was made after positive nucleic acid amplification testing and cultures for Mycobacterium tuberculosis from the drainage of the abscesses. After initiating antituberculous treatment, the patient had 2 instances of immune reconstitution inflammatory syndrome. A combination of diminished immunosuppression due to discontinuation of mycophenolate mofetil in the setting of acute infection, rifampin drug interactions with cyclosporine, and the beginning of treatment of tuberculosis all contributed to this paradoxical worsening. The patient responded favorably to increased glucocorticoid therapy and showed no signs of treatment failure after 6 months of antituberculous therapy.
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Affiliation(s)
- Rita Lino
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Sandra Amorim
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cláudio Silva
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Nélia Neves
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paulo Araújo
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Roberto Pinto
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Pinheiro-Torres
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paulo Pinho
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Filipe Macedo
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lurdes Santos
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; ESCMID Study Group for Infections in Compromised Hosts, European Society of Clinical Microbiology and Infectious Diseases
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Molla Y, Wubetu M, Dessie B. Anti-Tuberculosis Drug Induced Hepatotoxicity and Associated Factors among Tuberculosis Patients at Selected Hospitals, Ethiopia. Hepat Med 2021; 13:1-8. [PMID: 33536799 PMCID: PMC7850419 DOI: 10.2147/hmer.s290542] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/15/2020] [Indexed: 12/14/2022] Open
Abstract
Background Tuberculosis caused by susceptible mycobacterium tuberculosis strains is effectively treated by the first-line anti-tuberculosis drugs. However, most antibacterial drugs are known to induce hepatotoxicity which may limit their adherence and hence lead to the development of mycobacterial drug resistance. Objective The aim of this study was to assess the incidence of anti-tuberculosis drug induced hepatotoxicity and associated factors among tuberculosis patients of Debre Markos, Mota, and Bichena Hospitals. Methods The prospective cross sectional-study was conducted in three hospitals of East Gojjam zone by taking blood samples of new tuberculosis patients every 2 weeks for 2 months to measure the elevation of liver proteins indicating liver toxicity from the onset of starting therapy. A semi-structured questionnaire was also used to collect the socio-demographic data and factors of anti-tubeculosis drug induced liver toxicity. To identify factors associated with drug induced hepatotoxicity, binary logistic regression followed by multivariate analysis was applied at a statistically significant level of P<0.05. Results The incidence of hepatotoxicity among tuberculosis patients is 7.9%. Diagnosis of extrapulmonary tuberculosis, having comorbid disease, and old age are significantly associated (P<0.05) with first-line antituberculosis drugs induced hepatotoxicity. Conclusion The incidence of hepatotoxicity is relatively high among tuberculosis patients taking first-line anti-tuberculosis drugs. Therefore, the liver function of patients with old age, comorbid diseases, and extrapulmonary tuberculosis should be regularly monitored to reduce the severity of drug-induced hepatotoxicity.
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Affiliation(s)
- Yalew Molla
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Muluken Wubetu
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Bekalu Dessie
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
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Riccardi N, Ferrarese M, Castellotti P, Mazzola E, Sozzi F, Rigatti P, Vanzulli A, Sotgiu G, Codecasa L. A rare case of multi-focal human TB after BCG instillation for non-muscle-invasive bladder cancer. Urologia 2019; 87:199-202. [PMID: 31271544 DOI: 10.1177/0391560319860396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To describe a left epididymitis and para-aortical involvement caused by Mycobacterium tuberculosis hominis reactivation after bacillus Calmette-Guérin instillation for non-muscle-invasive bladder cancer. PATIENT AND METHODS A Caucasian male, aged 76 years, exposed to bacillus Calmette-Guérin for a high-grade non-muscle-invasive bladder cancer in 2015, reported painful and progressive left scrotal swelling with purulent discharge from a cutaneous fistulous track that yielded, on liquid culture, a pan-susceptible Mycobacterium tuberculosis hominis strain. Moreover, after 6 months of anti-tuberculosis treatment, an abdominal peri-aortic mass, sized 4 cm, was found and a surgical biopsy showed necrotizing granulomas; however, although smear microscopy and Xpert MTB/Rif™ performed on fresh biopsy sample were positive, liquid cultures resulted negative, indicating treatment efficacy. RESULTS Numerous peculiar and multi-organ involvement due to BCGitis after intravesical immunotherapy have been previously described, including 17 scientific articles about epididymitis, however, no reports so far showed reactivation of Mycobacterium tuberculosis hominis after bacillus Calmette-Guérin treatment. CONCLUSION Although BCGitis is more prevalent in patients undergoing bacillus Calmette-Guérin instillation for non-muscle-invasive bladder cancer, tuberculosis by other species of Mycobacterium tuberculosis should be always ruled out by molecular and conventional microbiology in patients with a history of Mycobacterium tuberculosis hominis exposure.
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Affiliation(s)
- Niccolò Riccardi
- Clinic of Infectious Diseases, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy.,StopTB Italia Onlus, Milan, Italy
| | - Maurizio Ferrarese
- StopTB Italia Onlus, Milan, Italy.,Regional TB Reference Centre and Laboratory, Villa Marelli Institute/ASST Niguarda Ca' Granda Hospital, Milan, Italy
| | - Paola Castellotti
- StopTB Italia Onlus, Milan, Italy.,Regional TB Reference Centre and Laboratory, Villa Marelli Institute/ASST Niguarda Ca' Granda Hospital, Milan, Italy
| | - Ester Mazzola
- Regional TB Reference Centre and Laboratory, Villa Marelli Institute/ASST Niguarda Ca' Granda Hospital, Milan, Italy
| | - Francesco Sozzi
- U.O. Urology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Angelo Vanzulli
- Departments of Diagnostic and Interventional Radiology and Oncology and Hemato-oncology, Niguarda Ca' Granda Hospital, University of Milan, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Luigi Codecasa
- StopTB Italia Onlus, Milan, Italy.,Regional TB Reference Centre and Laboratory, Villa Marelli Institute/ASST Niguarda Ca' Granda Hospital, Milan, Italy
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