Tuberculous lymphadenitis and the appearance of Behçet's disease-like symptoms

Multiple cutaneous and mucocutaneous lesions as manifestations of pseudo-Behçet's disease

Pseudo-Behçet's disease (PBD) is a close clinical mimicker of Behçet's disease (BD) which can present with orogenital ulceration and uveitis. However, these manifestations in PBD are associated with occult tuberculosis. Sometimes, diagnosis of PBD is established retrospectively when the lesions respond to anti-tubercular therapy (ATT). We here describe a case who presented with a penile ulcer, initially suspected to be a sexually transmitted infection, but was later diagnosed as PBD and resulted in complete healing with ATT. Knowledge about this condition is essential to prevent misdiagnosis as BD and unnecessary treatment with systemic corticosteroids, which can lead to worsening of tuberculosis.

Uveitis developing in tuberculous lymphadenitis-associated Behçet's disease during anti-tuberculosis therapy

Behçet's disease (BD) is thought to be elicited by triggers such as tuberculosis (TB) infection in individuals with genetically aberrant immune activity, although the exact pathogenesis remains unknown. Seven cases of BD thought to be triggered by TB have been reported to date. In all cases, Behçet's symptoms improved smoothly after starting TB treatment. We present the first report of uveitis developing two months after starting TB treatment in a 46-year-old woman with tuberculous lymphadenitis presenting with oral and genital ulcers and erythema nodosum-like lesions on diagnosis of TB. The appearance of uveitis was attributed to a paradoxical reaction in TB because of simultaneous relapse of lymphadenopathy and retinal findings on fluorescein angiography. Although rare, physicians should be aware that ocular involvement can occur during anti-TB therapy, most likely with extrapulmonary TB, because ocular involvement may decrease patient quality of life if visual symptoms become irreversible with delayed diagnosis and treatment.

Recent approaches of lipid-based delivery system for lymphatic targeting via oral route

Lymphatic system is a key target in research field due to its distinctive makeup and huge contributing functions within the body. Intestinal lymphatic drug transport (chylomicron pathway) is intensely described in research field till date because it is considered to be the best for improving oral drug delivery by avoiding first pass metabolism. The lymphatic imaging techniques and potential therapeutic candidates are engaged for evaluating disease states and overcoming these conditions. The novel drug delivery systems such as self-microemulsifying drug delivery system, nanoparticles, liposomes, nano-lipid carriers, solid lipid carriers are employed for delivering drugs through lymphatic system via various routes such as subcutaneous route, intraperitoneal route, pulmonary route, gastric sub-mucosal injection, intrapleural and intradermal. Among these colloidal particles, lipid-based delivery system is considered to be the best for lymphatic delivery. From the last few decades, mesenteric lymph duct cannulation and thoracic lymph duct cannulation are followed to assess lymphatic uptake of drugs. Due to their limitations, chylomicrons inhibitors and in-vitro models are employed, i.e. lipolysis model and permeability model. Currently, research on this topic still continues and drainage system used to deliver the drugs against lymphatic disease as well as targeting other organs by modulating the chylomicron pathway.