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Nakou I, Kotoulas SC, Sionidou M, Daios S, Manika C, Hadji-Mitrova M, Papadaki E, Manika K. Two Cases of Testicular Tuberculosis and Review of the Recent Literature. Int J Mycobacteriol 2024; 13:225-236. [PMID: 39277883 DOI: 10.4103/ijmy.ijmy_130_24] [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: 05/28/2024] [Accepted: 07/23/2024] [Indexed: 09/17/2024] Open
Abstract
In this review, two cases of testicular tuberculosis (TB) are presented, and another 58 cases published in PubMed between January 1, 2012, and July 31, 2023, are reviewed. Testicular TB remains a disease mainly of the developing world, with one notable exception - the infections caused as a result of Bacillus Calmette-Guérin infusion immunotherapy for bladder cancer. Its clinical course is subacute; however, it might get disseminated and become life-threatening; therefore, prompt diagnosis is very important. The diagnosis can be quite challenging, and testicular tissue is the sample with the highest diagnostic yield, either for microbiological or histopathological diagnosis. On the other hand, its treatment follows the standard guidelines for TB treatment; however, the avoidance of an unnecessary orchiectomy is important.
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Affiliation(s)
- Ifigeneia Nakou
- Pulmonary Department, Respiratory Infections Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Serafeim-Chrysovalantis Kotoulas
- Pulmonary Department, Respiratory Infections Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Intensive Care Unit, Hippocration General Hospital, Thessaloniki, Greece
| | - Maria Sionidou
- Pulmonary Department, Respiratory Infections Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stylianos Daios
- Pulmonary Department, Respiratory Infections Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Manika
- Department of Radiology, "Agios Pavlos" General Hospital, Thessaloniki, Greece
| | - Marija Hadji-Mitrova
- Pulmonary Department, Respiratory Infections Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Papadaki
- Pulmonary Department, Respiratory Infections Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Katerina Manika
- Pulmonary Department, Respiratory Infections Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Basnayake O, Jayarajah U, Beneragama T. Tuberculosis of the wrist causing carpal tunnel syndrome in a patient with rheumatoid arthritis: A case report. SAGE Open Med Case Rep 2024; 12:2050313X231225871. [PMID: 38222941 PMCID: PMC10787524 DOI: 10.1177/2050313x231225871] [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: 07/29/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024] Open
Abstract
Among extrapulmonary tuberculosis, osteoarticular tuberculosis is a rare manifestation, and cases related to osteoarticular tuberculosis of large joints have been reported previously. However, tuberculous tenosynovitis causing carpal tunnel syndrome is a rare manifestation, especially in the background of rheumatoid arthritis. A 67-year-old Sri Lankan male with a background of rheumatoid arthritis presented with progressively enlarging left wrist swelling associated with pain and numbness for 2 months. He was on Methotrexate and Hydroxychloroquine as disease-modifying agents, and his symptoms related to arthritis were well controlled. On examination, lobulated subcutaneous swelling was noted in distal forearm extending to the palmar region with evidence of carpal tunnel syndrome which was confirmed by nerve conduction studies. There was no pre-operative evidence to suggest tuberculosis both clinically and biochemically. Synovial thickening due to rheumatoid arthritis was considered as the probable diagnosis and surgical decompression of the carpal tunnel was performed. Intraoperatively, synovial thickening was noted around the flexor tendons with evidence of median nerve compression in the carpal tunnel. Thickened synovial mass was completely excised. Histology and culture were positive for tuberculosis. Following excision and 9 months of anti-tuberculosis treatment, he was asymptomatic with good range of motion of fingers. In conclusion, a combination of surgical excision and anti-tuberculosis treatment was successful to achieve good functional outcomes. In a country like Sri Lanka, where tuberculosis is still prevalent, uncommon musculoskeletal manifestations may not be infrequent. Therefore, clinicians should have a high degree of suspicion when treating such patients.
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Affiliation(s)
- Oshan Basnayake
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Department of Plastic and Reconstructive Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Umesh Jayarajah
- Department of Plastic and Reconstructive Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Thushan Beneragama
- Department of Plastic and Reconstructive Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Mir N, Pal L. Genital tuberculosis, infertility and assisted reproduction. Curr Opin Obstet Gynecol 2023; 35:263-269. [PMID: 36912346 DOI: 10.1097/gco.0000000000000866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to familiarize a global readership on the subtilities of clinical presentation and the mayhem that a missed diagnosis of genital tuberculosis (GTB) is capable of inflicting on the health and wellbeing of infertile women with untreated GTB attempting to conceive with assisted reproductive technology (ART). RECENT FINDINGS Emerging and recent literature relating to the epidemiology and clinical presentation of GTB and reporting of unique risks of ART for maternal and fetal morbidity in untreated cases of GTB are reviewed. Evidence relating to a broadening spectrum of screening methodologies for GTB detection of GTB is additionally considered. SUMMARY Genital TB must be considered as a mechanism for couple's infertility in at-risk populations. Attempting to treat female GTB-related infertility with in-vitro fertilization poses unique and potentially life-threatening risks, both to the mother and to the conceptus; these risks can be avoided through vigilance, appropriate screening and timely treatment prior to proceeding with IVF.
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Affiliation(s)
| | - Lubna Pal
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, Connecticut, USA
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Tzelios C, Neuhausser WM, Ryley D, Vo N, Hurtado RM, Nathavitharana RR. Female Genital Tuberculosis. Open Forum Infect Dis 2022; 9:ofac543. [PMID: 36447614 PMCID: PMC9697622 DOI: 10.1093/ofid/ofac543] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/20/2022] [Indexed: 06/21/2024] Open
Abstract
Female genital tuberculosis (FGTB) is an important cause of morbidity and infertility worldwide. Mycobacterium tuberculosis most commonly spreads to the genital tract from a focus elsewhere in the body and affects the bilateral fallopian tubes and/or endometrium. Many patients with FGTB have indolent disease and are only diagnosed after evaluation for infertility. Women may present with menstrual irregularities, lower abdominal or pelvic pain, or abnormal vaginal discharge. Given the low sensitivity of diagnostic tests, various composite reference standards are used to diagnose FGTB, including some combination of endoscopic findings, microbiological or molecular testing, and histopathological evidence in gynecological specimens. Early treatment with a standard regimen of a 2-month intensive phase with isoniazid, rifampin, ethambutol, and pyrazinamide, followed by a 4-month continuation phase with isoniazid and rifampin, is recommended to prevent irreversible organ damage. However, even with treatment, FGTB can lead to infertility or pregnancy-related complications, and stigma is pervasive.
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Affiliation(s)
- Christine Tzelios
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Werner M Neuhausser
- Division of Reproductive Endocrinology and Infertility, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - David Ryley
- Division of Reproductive Endocrinology and Infertility, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
- Boston IVF, Boston, Massachusetts, USA
| | - Nhi Vo
- Division of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Rocio M Hurtado
- Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ruvandhi R Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Bandara GBKD, Jayarajah U, Rodrigo VSD. Renal inflammatory myofibroblastic tumour presenting with a large retroperitoneal abscess. SAGE Open Med Case Rep 2022; 10:2050313X221089484. [PMID: 35401980 PMCID: PMC8984842 DOI: 10.1177/2050313x221089484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/07/2022] [Indexed: 11/21/2022] Open
Abstract
Inflammatory myofibroblastic tumour arising from the kidney is a rare occurrence. In this
case report, we present a rare case of inflammatory myofibroblastic tumour arising from
the kidney diagnosed after the presentation with a large retroperitoneal abscess for the
first time in literature. A 55-year-old woman with diabetes mellitus presented to us with
painful lump in the left lumbar region of the back for 1-week duration. On examination,
there was a firm, diffuse lump in the left lumbar region of the back. Her inflammatory
markers were high, but the serum creatinine and blood urea were within the normal range.
Abdominal ultrasonography showed a distorted left kidney with a heterogeneous mass
consisting cystic and solid components measuring approximately 7 × 9 × 8 cm in size. A
contrast-enhanced computed tomography scan showed an 11 × 9 × 9 cm-sized low-density mass
posterior to the left kidney with multiple contrast-enhancing septations which appeared
posterior to but separate from the left kidney within the left renal fascia. There was
breeching of the Gerota’s fascia with extension posteriorly up to subcutaneous tissue.
Since the radiological opinion was in favour of a complex perinephric abscess, open
drainage of the abscess was performed after failed attempts of ultrasound-guided drainage.
The biopsy of the abscess wall was suggestive of a renal cell carcinoma and radical
nephrectomy was planned. Due to tumour invasion, the radical nephrectomy was combined with
a splenectomy and the specimen sent for histology. It showed an inflammatory
myofibroblastic tumour or pseudotumour with the periphery showing ulceration and abscess
formation. The patient had an uneventful recovery following surgery. Thus, we report the
first case of renal inflammatory myofibroblastic tumour presenting with a large
retroperitoneal abscess extending to the subcutaneous tissue plane. Final diagnosis was
made only after radical surgery which was curative.
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Affiliation(s)
| | - Umesh Jayarajah
- Department of Surgery, District General Hospital, Chilaw, Sri Lanka
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