Subacute Cardiac Tamponade Due to Tuberculous Pericarditis Diagnosed by Urine Lipoarabinomannan Assay in a Immunocompetent Patient in Oyam District, Uganda: A Case Report

Clinical and epidemiological characterization of patients with cutaneous tuberculosis treated at a referral center in the Brazilian Amazon: case series

BACKGROUND

Cutaneous tuberculosis is a rare form of the disease that defies diagnosis due to the diversity of clinical presentations. This study was based on the reality of a dermatology referral center in the Brazilian Amazon region to detail several characteristics of this disease.

OBJECTIVE

To describe a series of cases of cutaneous tuberculosis treated at a dermatology service in the Brazilian Amazon region, addressing epidemiological aspects, clinical forms, diagnostic methods, treatment, and outcomes.

METHODS

This is a descriptive and observational study of the case series type, including eight patients with a confirmed diagnosis of cutaneous tuberculosis seen between 2021 and 2023. A standardized protocol was used to collect data from patients' medical records.

RESULTS

Among the eight cases of cutaneous tuberculosis, there were four cases of erythema induratum of Bazin, one case of tuberculosis verrucosa cutis, two cases of scrofuloderma, and one case of lupus vulgaris. Erythema induratum of Bazin, the most common form in the study, occurred predominantly in women, presenting as infiltrated plaques and erythematous nodules. All eight cases were treated with the standard therapeutic regimen of the Brazilian Ministry of Health (rifampicin, isoniazid, pyrazinamide, and ethambutol).

STUDY LIMITATIONS

They include the small sample size, making generalizations difficult.

CONCLUSIONS

The study addressed the clinical diversity of cutaneous tuberculosis, with erythema induratum of Bazin as the most common form. The importance of the socioeconomic context in the prevalence of the disease and the need for more comprehensive epidemiological studies to improve the understanding of cutaneous tuberculosis, especially in endemic regions, are highlighted.

Cardiac Tuberculosis: A Case Series from Ethiopia, Italy, and Uganda and a Literature Review

Extrapulmonary tuberculosis (TB) is estimated to account for up to 20% of active cases of TB disease, but its prevalence is difficult to ascertain because of the difficulty of diagnosis. Involvement of the heart is uncommon, with constrictive pericarditis being the most common cardiac manifestation. Diagnostic research for cardiac disease is frequently lacking, resulting in a high mortality rate. In addition to direct cardiac involvement, instances of cardiac events during antitubercular therapy are described. This case series describes five cases of TB affecting the heart (cardiac TB) from Italy and high-burden, low-income countries (Ethiopia and Uganda), including a case of Loeffler syndrome manifesting as myocarditis in a patient receiving antitubercular therapy. Our study emphasizes how cardiac TB, rare but important in high-burden areas, is a leading cause of pericardial effusion or pericarditis. Timely diagnosis and a comprehensive approach, including imaging and microbiological tools, are crucial. Implementing high-sensitivity methods and investigating alternative samples, such as detection of tuberculosis lipoarabinomannan or use of the GeneXpert assay with stool, is recommended in TB control programs.

Comments and Illustrations of Ultrasound Findings in Extrapulmonary Tuberculosis Manifestations

This review describes the appearance of extrapulmonary tuberculosis manifestations in comprehensive and multiparametric ultrasound imaging. The aim is to increase awareness of typical ultrasound findings regarding extrapulmonary tuberculosis, correlate those with pathological features, and facilitate differential diagnosis. Point of care ultrasound protocols can be used as a screening method in high-risk populations, although the negative findings do not exclude tuberculosis. Conversely, the diagnosis of extrapulmonary tuberculosis can never be made using ultrasound alone, as many ultrasound findings in extrapulmonary tuberculosis are non-specific. However, ultrasound-based sampling techniques can significantly facilitate the collection of samples for microbiological or molecular proof of tuberculosis, as well as facilitating the establishment of alternative diagnoses.

Cardiovascular Involvement in Tuberculosis: From Pathophysiology to Diagnosis and Complications-A Narrative Review

Although primarily a lung disease, extra-pulmonary tuberculosis (TB) can affect any organ or system. Of these, cardiovascular complications associated with disease or drug toxicity significantly worsen the prognosis. Approximately 60% of patients with TB have a cardiovascular disease, the most common associated pathological entities being pericarditis, myocarditis, and coronary artery disease. We searched the electronic databases PubMed, MEDLINE, and EMBASE for studies that evaluated the impact of TB on the cardiovascular system, from pathophysiological mechanisms to clinical and paraclinical diagnosis of cardiovascular involvement as well as the management of cardiotoxicity associated with antituberculosis medication. The occurrence of pericarditis in all its forms and the possibility of developing constrictive pericarditis, the association of concomitant myocarditis with severe systolic dysfunction and complication with acute heart failure phenomena, and the long-term development of aortic aneurysms with risk of complications, as well as drug-induced toxicity, pose complex additional problems in the management of patients with TB. In the era of multidisciplinarity and polymedication, evidence-based medicine provides various tools that facilitate an integrative management that allows early diagnosis and treatment of cardiac pathologies associated with TB.