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Deng LJ, Ye Q, Luo SY, Wang QX, Fang S. Case Report: Clinical and Pathological Findings of Tuberculous Gumma: A Case Report and Literature Review. Am J Trop Med Hyg 2024; 110:805-808. [PMID: 38471180 PMCID: PMC10993822 DOI: 10.4269/ajtmh.23-0510] [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: 08/02/2023] [Accepted: 12/20/2023] [Indexed: 03/14/2024] Open
Abstract
Tuberculous gumma (TG) is a rare type of cutaneous tuberculosis thought to occur as a result of the hematogenous spread of Mycobacterium tuberculosis, which is more common in immunosuppressed individuals. An 8-year-old boy presented with a 2-month history of multiple indolent enlarging ulcerated nodules on his left upper extremity. He had a past medical history of bacille Calmette-Guerin vaccine induced lupus vulgaris. Skin biopsy of the nodules showed granulomas and neutrophil-dominated purulent inflammation. Ziehl-Neelsen staining was negative, and the cultures were positive for M. tuberculosis. Furthermore, the M. tuberculosis complex was identified using metagenomic next-generation sequencing. Standard antitubercular therapy was started at full doses, and the skin lesions had significantly improved 3 months later. Here we review the literature since 2000 and describe the clinical and pathological features of TG.
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Affiliation(s)
- Li-Jia Deng
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Ye
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Dermatology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Si-Yu Luo
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Dermatology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Qin-Xiao Wang
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Sheng Fang
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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2
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Jahanshahi A, Nami S, Hosein Pour Feizi AA, Alihosseini S, Jaberinezhad M, Abdollahi M, Rahimi F, Falahatian M. Muscular and hepatosplenic candidiasis in a patient with acute myeloblastic leukemia: A case report and literature review. Clin Case Rep 2023; 11:e7700. [PMID: 37476594 PMCID: PMC10354359 DOI: 10.1002/ccr3.7700] [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] [Received: 01/18/2023] [Revised: 06/24/2023] [Accepted: 06/29/2023] [Indexed: 07/22/2023] Open
Abstract
Key Clinical Message Muscular and subcutaneous candidiasis is a rare entity in immunocompromised patients, but it should be kept in mind when we see multiple cystic soft tissue masses in addition to target-shaped hepatosplenic lesions in neutropenic patients. US and MRI are useful imaging modalities for the diagnosis and follow-up of these patients. Abstract Soft tissue candidiasis is an opportunistic infection in immunocompromised patients and must always be diagnosed and treated as soon as possible. In this case report, the patient is a 14-year-old boy with acute myeloid leukemia M3-type who presented with numerous soft tissue and hepatosplenic candidal abscesses.
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Affiliation(s)
- Amirreza Jahanshahi
- Medical Radiation Sciences Research GroupTabriz University of Medical SciencesTabrizIran
- Department of RadiologyTabriz University of Medical SciencesTabrizIran
| | - Sanam Nami
- Department of Parasitology and MycologySchool of MedicineTabriz University of Medical SciencesTabrizIran
| | | | - Samin Alihosseini
- Medical Radiation Sciences Research GroupTabriz University of Medical SciencesTabrizIran
- Department of RadiologyTabriz University of Medical SciencesTabrizIran
| | | | - Mirsaeed Abdollahi
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
| | - Faezeh Rahimi
- Department of RadiologyZanjan University of Medical SciencesZanjanIran
| | - Masih Falahatian
- Medical Radiation Sciences Research GroupTabriz University of Medical SciencesTabrizIran
- Department of RadiologyTabriz University of Medical SciencesTabrizIran
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3
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Dong J, Wang H. Multisystemic tuberculosis presenting with pulmonary, pleura, intestinal and bone involvement. Am J Med Sci 2022; 364:e4-e5. [PMID: 35675862 DOI: 10.1016/j.amjms.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 02/02/2022] [Accepted: 05/31/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Jinpei Dong
- Department of Gastroenterology, Peking University First Hospital, Xicheng District, Beijing, China
| | - Huahong Wang
- Department of Gastroenterology, Peking University First Hospital, Xicheng District, Beijing, China.
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[CT spectral curve in differentiating spinal tumor metastasis and infections]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021. [PMID: 33550354 PMCID: PMC7867981 DOI: 10.19723/j.issn.1671-167x.2021.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate the value of CT spectral curve in differentiating spinal tumor metastasis (STM) from spinal infections (SI). METHODS In the study, 29 STM and 18 SI patients proved pathologically and clinically were examined by dual energy spectral CT (DESCT). The monochromatic images and CT spectral curves were generated automatically by GSI Viewer software. The attenuation values at different energy levels (40-140 keV, every 10 keV), the attenuation values of the lesions on the conventional polychromatic CT images and the gradients of the curve were calculated and compared between STM and SI. RESULTS The median age of STM and SI (58 years vs. 64 years) were not significantly different (U=171, P=0.4). The attenuation values of STM at 40-100 keV were 281.79 (143.67, 446.19) HU, 199.68 (100.04, 321.49) HU, 151.54 (81.47, 243.49) HU, (122.64±27.72) HU, (99.90±23.88) HU, (85.82±21.61) HU, and (75.94±20.27) HU, respectively, which were significantly higher than SI: 185.29 (164.19, 277.03) HU, 138.44 (124.98, 238.56) HU, 105.46 (92.94, 169.53) HU, (93.77±15.55) HU, (79.15±12.84) HU, (68.99±11.75) HU, and (62.22±11.71) HU (all P < 0.05). The attenuation values at 110-140 keV and the attenuation value on the conventional CT images were not significantly different between STM and SI. The gradient of CT spectral curve of STM was 2.43±0.58, which was higher than the value of 1.50±0.40 for SI (P < 0.001). Using 1.72 and 248.80 HU as the threshold value for CT spectral curve slope and the attenuation value at 40 keV, could obtain the area under receiver operating characteristic (ROC) curve of 0.905 and 0.892, sensitivity of 88.0% and 80.0%, and specificity of 76.9% and 92.3%. CONCLUSION CT spectral curve provides valuable semi-quantitative information for the differential diagnosis of STM and SI, which can be used as a supplement to traditional CT imaging.
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Ladumor H, Al-Mohannadi S, Ameerudeen FS, Ladumor S, Fadl S. TB or not TB: A comprehensive review of imaging manifestations of abdominal tuberculosis and its mimics. Clin Imaging 2021; 76:130-143. [PMID: 33596517 DOI: 10.1016/j.clinimag.2021.02.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/21/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023]
Abstract
The ever-growing prevalence of tuberculosis is a cause for concern among both developing and developed countries. Abdominal tuberculosis is the most common site of extrapulmonary tuberculosis and involves almost all of the visceral organs. Clinical presentation of abdominal tuberculosis is often non-specific. Thus, having a high index of clinical suspicion is necessary to aide early diagnosis and guide prompt initiation of appropriate treatment. In this review, we focus on the entire spectrum of abdominal tuberculosis and other diseases mimicking it with an emphasis on their imaging findings.
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Affiliation(s)
- Heta Ladumor
- Weill Cornell Medicine - Qatar, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar.
| | - Salma Al-Mohannadi
- Weill Cornell Medicine - Qatar, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar
| | | | - Sushila Ladumor
- Department of Radiology, Hamad General Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Shaimaa Fadl
- Department of Radiology, Virginia Commonwealth University, West Hospital, 1200 East Broad Street, Room 2-013, Box 984070, Richmond, VA, 23298, United States of America
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Yuan Y, Lang N, Yuan H. Rapid-kilovoltage-switching dual-energy computed tomography (CT) for differentiating spinal osteolytic metastases from spinal infections. Quant Imaging Med Surg 2021; 11:620-627. [PMID: 33532262 DOI: 10.21037/qims-20-334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Rapid-kilovoltage-switching dual-energy computed tomography (RDECT) is a non-invasive, alternative technique for quantitative diagnosis. This study aimed to investigate the value of RDECT for differentiating spinal osteolytic metastases (SOM) from spinal infections (SIs). Methods RDECT was performed on 29 patients with SOM and 18 patients with SIs. Both iodine-based and water-based material decomposition images were generated from the spectral CT scan. The iodine/water densities of lesions on iodine/water material-decomposition images and the CT attenuation values on traditional CT images were measured three times at different image levels, and the averages were calculated. The lesion-to-muscle ratio (LMR) and lesion-to-artery ratio (LAR) for iodine density measurements were calculated. All parameters were compared between the two groups using the two-tailed Student's t-test. A P value <0.05 was considered statistically significant. The sensitivity and specificity for differentiating SOM from SIs were determined using receiver operating characteristic curves (ROC). Results Iodine density, LMR, and LAR during the arterial phase (AP) and venous phase (VP) were all significantly higher for SOM than for SIs (all P<0.05). The water densities and traditional CT attenuation values during the AP and VP were not significantly different between the two groups. For ROC analysis, LAR during the VP (LARVP) showed the best diagnostic performance, with an area under the ROC curve (AUC) value of 0.862. When the LARVP was 0.54, the sensitivity was 82.80% and the specificity was 77.80% for differentiating SOM from SIs. Conclusions RDECT can provide additional information that may be useful for differentiating atypical SOM from SIs.
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Affiliation(s)
- Yuan Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Ning Lang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China
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Bikoroti JB, Buteera AM, Manirakiza F, Munezero L, Nzarora J, Nyiraneza S. Tuberculosis of the Left Calcaneum and Collapsed Right Femoral Head: A Case Report. J Orthop Case Rep 2021; 11:55-58. [PMID: 34141643 PMCID: PMC8046462 DOI: 10.13107/jocr.2021.v11.i01.1962] [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: 11/30/2022] Open
Abstract
Introduction Tuberculosis (TB), one of the oldest diseases known to affect humans, is caused by the bacteria Mycobacterium tuberculosis. The disease usually affects the lungs, although, in up to one-third of cases, other organs are involved. TB of the bone mimics other clinical conditions such as chronic osteomyelitis, Madura mycosis and actinomycosis. Case Report A fifth child and last-born girl, in a family of living four children, aged 9 years, consulted Kigali University Teaching Hospital (CHUK) on December 7, 2017, from Kibuye Referral Hospital (Western of Rwanda) for ulcerated, infected left heel with swollen foot 4 months before our consultation. Physical examination revealed a patient with swollen and tender foot discharging serous bloody fluids accompanied by inability to stand with a painful right hip. Small left inguinal lymph nodes were present. Blood work-up, computed tomography scan of the left foot, and an incisional biopsy at the level of the left calcaneus were performed and revealed extrapulmonary TB. The histopathological features for TB were scanty, but the high index suspicion of possible extrapulmonary TB led to the confirmation of the diagnosis using auramine-rhodamine special stain. Anti-TB therapy for 12 months course was initiated and the monthly follow-up for 11 months was done. Conclusion Although calcaneal TB is very rare, in countries with high incidence of TB, clinicians must have a high suspicion index and skeletal TB must be included in differential diagnosis of bone masses whenever possible bone mass biopsy and special staining technique in addition to most common diagnosis means should be done to rule out the possibility of bone TB.
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Affiliation(s)
| | | | - Felix Manirakiza
- Department of Pathology, Kigali University Teaching Hospital, Rwanda.,Department of Clinical Biology, School of Medicine and Pharmacy, University of Kigali
| | - Louise Munezero
- Department of Clinical Biology, School of Medicine and Pharmacy, University of Kigali
| | - Josué Nzarora
- Department of Anaesthesia, Kigali University Teaching Hospital, Rwanda
| | - Sabine Nyiraneza
- Department of Radiology, Kigali University Teaching Hospital, Rwanda
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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.
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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
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Nataprawira HM, Ediwan NA, Diana IA, Dwiyana RF, Febrina D. Multifocal Osteomyelitic Tuberculosis at Rare Locations with Metastatic Tuberculosis Abscess. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:503-507. [PMID: 30975973 PMCID: PMC6474155 DOI: 10.12659/ajcr.913615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patient: Female, 9 Final Diagnosis: Multifocal osteomyelitic tuberculosis at rare locations with metastatic tuberculosis abscess Symptoms: Lumps at the left elbow joint • lateral side the left hand • lateral side of the left feet Medication: — Clinical Procedure: — Specialty: Pediatrics and Neonatology
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Affiliation(s)
- Heda Melinda Nataprawira
- Department of Child Health, Universitas Padjadjaran - Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Natasha A Ediwan
- Department of Child Health, Universitas Padjadjaran - Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Inne Arline Diana
- Department of Dermato-Venerology, Universitas Padjadjaran - Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Reiva Farah Dwiyana
- Department of Dermato-Venerology, Universitas Padjadjaran - Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Dia Febrina
- Department of Dermato-Venerology, Universitas Padjadjaran - Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
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Kaur A, Kucheria M, Gupta R, Thami GP, Kundu R. Extensive Multisystemic Disseminated Tuberculosis in an Immunocompetent Patient. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2018; 11:42-46. [PMID: 30319731 PMCID: PMC6169601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Extrapulmonary tuberculosis is uncommon and has an insidious onset with slow evolution and a paucibacillary nature. Here, we present a case of disseminated tuberculosis in an adult immunocompetent man presenting with morphologically different types of cutaneous lesions (i.e., multiple subcutaneous abcesses and multiple noduloulcerative lesions with discharging sinuses with seropurulent fluid). Extensive screening in the form of routine blood investigations, serologies, skin biopsy, Montoux test, sputum examination, chest and skull roentgenogram, noncontrast computed tomography chest and abdomen, contrast-enhanced computed tomography of the skull, and magnetic resonance imaging of lumbosacral spine with screening of the whole spine revealed extensive involvement of the skin, subcutaneous tissue, lungs, lymph nodes, skull bone, mandible, ribs, scapula, pelvis and Pott's spine, and thyroid.
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Affiliation(s)
- Amrit Kaur
- Drs. Kaur, Kucheria, and Thami are with the Department of Dermatology, Venereology, and Leprosy and the Government Medical College and Hospital in Chandigarh, India
- Dr. Gupta is with the Department of Radiodiagnosis at the Government Medical College and Hospital in Chandigarh, India
- Dr. Kundu is with the Department of Pathology at the Government Medical College and Hospital in Chandigarh, India
| | - Monika Kucheria
- Drs. Kaur, Kucheria, and Thami are with the Department of Dermatology, Venereology, and Leprosy and the Government Medical College and Hospital in Chandigarh, India
- Dr. Gupta is with the Department of Radiodiagnosis at the Government Medical College and Hospital in Chandigarh, India
- Dr. Kundu is with the Department of Pathology at the Government Medical College and Hospital in Chandigarh, India
| | - Rekha Gupta
- Drs. Kaur, Kucheria, and Thami are with the Department of Dermatology, Venereology, and Leprosy and the Government Medical College and Hospital in Chandigarh, India
- Dr. Gupta is with the Department of Radiodiagnosis at the Government Medical College and Hospital in Chandigarh, India
- Dr. Kundu is with the Department of Pathology at the Government Medical College and Hospital in Chandigarh, India
| | - Gurvinder Pal Thami
- Drs. Kaur, Kucheria, and Thami are with the Department of Dermatology, Venereology, and Leprosy and the Government Medical College and Hospital in Chandigarh, India
- Dr. Gupta is with the Department of Radiodiagnosis at the Government Medical College and Hospital in Chandigarh, India
- Dr. Kundu is with the Department of Pathology at the Government Medical College and Hospital in Chandigarh, India
| | - Reetu Kundu
- Drs. Kaur, Kucheria, and Thami are with the Department of Dermatology, Venereology, and Leprosy and the Government Medical College and Hospital in Chandigarh, India
- Dr. Gupta is with the Department of Radiodiagnosis at the Government Medical College and Hospital in Chandigarh, India
- Dr. Kundu is with the Department of Pathology at the Government Medical College and Hospital in Chandigarh, India
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Li Z, Wang S, Chen X, Ming X, Peng L, Li W. Unlocking the mystery of persistent skin ulcers in a young man and successful treatment with a simple regimen. Dermatol Ther 2018; 31:e12600. [PMID: 29687600 DOI: 10.1111/dth.12600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 03/18/2018] [Indexed: 02/05/2023]
Abstract
Despite the high prevalence of pulmonary tuberculosis worldwide, extrapulmonary tuberculosis especially cutaneous and osteoarticular tuberculosis occurs rarely, both of which are often difficult to be recognized since their symptoms mimic those of many other cutaneous and osteoarticular diseases. Here, we present a rare case of cutaneous tuberculosis potentially accompanied by osteroarticular tuberculosis in a 36-year-old Chinese man who presented with multiple persistent skin ulcers for one year and were nonresponsive to multiple therapeutic approaches. A single anti-tuberculous regimen with rifampicin resulted in healing of all skin lesions and excellent recovery of the general condition.
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Affiliation(s)
- Zhongtao Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sheng Wang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaomei Chen
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinran Ming
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Peng
- Department of Pulmonary Medicine, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China.,Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Wei Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Mohta S, Kumar A, Singh N, Wig N. A case of tuberculous gumma: there is more to it than meets the eye. BMJ Case Rep 2017; 2017:bcr-2017-221701. [PMID: 29054947 DOI: 10.1136/bcr-2017-221701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of a young girl who presented with multiple cutaneous abscesses over 2 years at different sites. She had no constitutional symptoms or history of tuberculosis. On investigation, she was found to have rifampicin-sensitive tuberculosis presenting as tubercular gumma, a rare form of cutaneous tuberculosis which occurs due to haematogenous spread of the bacilli. She had disseminated disease involving the spinal column with associated psoas abscess. A thorough evaluation was done for immune-deficiency workup but was all negative. She was given antitubercular therapy and showed a good response to therapy at a follow-up of 1 month.
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Affiliation(s)
- Srikant Mohta
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nayani Singh
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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13
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Multifocal tuberculosis of long bones in an immunocompetent child. J Pediatr Orthop B 2016; 25:248-52. [PMID: 26600081 DOI: 10.1097/bpb.0000000000000239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although tuberculosis (TB) is prevalent in many parts of the world, multifocal TB involvement of bones is rare. It is believed that less than 5% of skeletal TB is multifocal. We report a case of multifocal TB of long bones in an immunocompetent child. We describe the radiological and diagnostic features of TB osteomyelitis and outline its therapy and prognosis. To the best of the authors' knowledge, such a case with multiple long bone involvement without articular sequel and visceral involvement/constitutional symptoms has not been reported previously in the literature.
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14
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Cutaneous and Skeletal Simultaneous Locations as a Rare Clinical Presentation of Tuberculosis. Case Rep Infect Dis 2015; 2015:618546. [PMID: 26064719 PMCID: PMC4430640 DOI: 10.1155/2015/618546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/09/2015] [Accepted: 04/16/2015] [Indexed: 12/02/2022] Open
Abstract
Tuberculosis is a resurgent disease in most regions of the world, infecting one-third of the world's population and having a multisystemic involvement. Incidence of extra-pulmonary tuberculosis has increased in the last few decades as a result of the Human Immunodeficiency Virus (HIV) infection. The authors report a clinical case of the rare concomitant cutaneous and skeletal tuberculosis in an immunocompetent patient transferred from endemic area.
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15
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Das CK, Mahapatra A, Das MM, Sahoo D, Chayani N. Coexistence of cutaneous tuberculosis (scrofuloderma) and hanseniasis-a rare presentation. J Clin Diagn Res 2014; 8:141-2. [PMID: 24701508 PMCID: PMC3972534 DOI: 10.7860/jcdr/2014/7050.4033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 12/19/2013] [Indexed: 11/24/2022]
Abstract
Cutaneous tuberculosis, pulmonary tuberculosis and hanseniasis are all caused by different spp. of Mycobacterium, an intracellular pathogen whose development depends on impaired cell mediated immunity. Scrofuloderma is the most common variant of cutaneous tuberculosis, which is characterized by a direct extension of the skin which overlies the infected lymph gland, bone or joint, that breaks down to form an undermined ulcer. We are reporting a rare association of Scrofuloderma (cutaneous tuberculosis) with Hanseniasis (leprosy) in an adult male whose immune status was controversial.
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Affiliation(s)
- Chandan Kumar Das
- Doctoral Student, Department of Microbiology,S.C.B Medical College, Cuttack, Odisha, India
| | - Ashoka Mahapatra
- Associate Professor, Department of Microbiology,AIIMS Bhubaneswar, Odisha, India
| | - Manasi Manaswini Das
- Doctoral Student, Department of Pharmacology,SCB Medical College, Cuttack, Odisha, India
| | - Debasish Sahoo
- Senior Resident, Department of Microbiology,SCB Medical College, Cuttack, Odisha, India
| | - Nirupama Chayani
- Professor and Head, Department of Microbiology,SCB Medical College, Cuttack, Odisha, India
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16
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Sahu S, Pattnaik S, Mohanty I, Narasimham MV, Panda P. Chronic osteomyelitis of humerus presenting as scrofuloderma. Indian J Dermatol 2013; 58:408. [PMID: 24082212 PMCID: PMC3778807 DOI: 10.4103/0019-5154.117344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Scrofuloderma is a common type of cutaneous tuberculosis usually manifests over an infected lymphnode, bone or joint that breaks down to form an undermined ulcer leading to discharging sinuses. We present a case of a 22 year old woman with diffuse swelling of right arm with overlying nodulo ulcerative skin lesions associated with seropurulent discharge. Routine investigations were normal and X-Ray of the right humerus showed the features of chronic osteomyelitis. Smears of the discharge for bacteria, fungi and acid fast bacilli were negative, but culture of skin biopsy showed Mycobacterium tuberculosis which was confirmed by PCR. Histopathology of skin biopsy showed epithelioid granulomatous inflammation suggestive of tuberculosis. After treating the patient with antitubercular therapy complete regression of the lesions occurred.
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Affiliation(s)
- Susmita Sahu
- Department of Microbiology, M.K.C.G Medical College, Berhampur, Odisha, India
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Abstract
Spinal tuberculosis usually occurs in a single vertebral body or two to three adjacent vertebrae; it rarely occurs in multiple vertebral bodies. Surgery is indicated in cases that do not improve with conservative therapy, or when paralysis is evident. Two cases regarding patients with spinal tuberculosis in multiple vertebral bodies on whom surgery was performed are reported. Case 1, the patient was a 77-year-old woman with spinal tuberculosis in four vertebral bodies from the lower thoracic to the lumbar spine. As she had pronounced lower back pain, posterolateral fusion with a pedicle screw was performed. Case 2, the patient was a 29-year-old Indonesian man with spinal tuberculosis in 17 vertebral bodies of the spine who was unable to stand due to paralysis of both legs, thus posterolateral fusion with a pedicle screw was performed. Good results were obtained from tuberculostatic drug therapy and surgical instrumentation.
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Verma S, Thakur BK, Gupta A. Multifocal childhood cutaneous tuberculosis: report of two interesting cases from Sikkim, India. Pediatr Dermatol 2013; 30:e1-4. [PMID: 22957927 DOI: 10.1111/j.1525-1470.2012.01834.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cutaneous tuberculosis is an important health problem in developing countries such as India. Poverty, overcrowding, malnutrition, and ignorance are predisposing factors. The commonly seen variants of cutaneous tuberculosis are scrofuloderma, lupus vulgaris, and tuberculosis verrucosa cutis. Malnourished children may present with unusual forms of cutaneous tuberculosis. Herein we report two interesting cases of multifocal cutaneous tuberculosis in malnourished children.
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Affiliation(s)
- Shikha Verma
- Departments of Dermatology Pathology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
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Rodrigo C, Atukorala I. Delay in diagnosis of generalized miliary tuberculosis with osseo-articular involvement: a case report. J Med Case Rep 2011; 5:512. [PMID: 21985613 PMCID: PMC3198717 DOI: 10.1186/1752-1947-5-512] [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: 05/20/2011] [Accepted: 10/10/2011] [Indexed: 12/03/2022] Open
Abstract
Introduction Diagnosis of atypical tuberculosis is difficult. Therefore, it is important that physicians are aware of rare presentations of tuberculosis to avoid diagnostic delays. Case presentation We present the case of a 17-year-old Sri Lankan man who presented to our facility with an ill-defined large induration over the skin of his left buttock and thigh. A cause could not be found despite extensive investigations. He also complained of chronic knee pain, but this was not investigated further at the time due to spontaneous resolution. Three years later his knee disease flared up again, with pain, swelling and restriction of movement. A synovial biopsy was suggestive of tuberculosis. He was started on antituberculosis therapy, to which he responded well. Our patient was asymptomatic two months after completion of therapy without any subsequent flare-ups. A chest roentgenogram taken on his second presentation showed evidence of tuberculosis sequelae in his lungs. The most likely diagnosis for the buttock and thigh swelling, when considering the entire clinical picture, is a tuberculous abscess. The constellation of skin and skeletal symptoms and pulmonary tuberculosis is a rare occurrence in an immunocompetent individual, but cases have been reported. Conclusions This case demonstrates the different presentations and the diagnostic difficulties posed by atypical manifestations of tuberculosis. It also demonstrates the value of maintaining a high degree of suspicion in endemic areas, even in the absence of microbiological evidence.
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Shukla S, Singh S, Puri V, Verma D, Jain L. Bilateral symmetrical facial swelling owing to tuberculous gummas. ACTA ACUST UNITED AC 2011; 31:363-5. [PMID: 22041472 DOI: 10.1179/1465328111y.0000000034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Metastatic tuberculous abscesses and gummas are unusual forms of cutaneous tuberculosis. They result from haematogeneous spread of the mycobacterium from a primary focus during a period of impaired immunity. A 5-year-old boy is reported who presented with spinal tuberculosis and bilateral subcutaneous swelling of the cheeks owing to tuberculous gummas.
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Affiliation(s)
- S Shukla
- Departments of Pathology and Pediatrics, Lady Hardinge Medical College, New Delhi, India
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