Clinical characteristics and outcome of genitourinary tuberculosis in Sri Lanka: an observational study

Tuberculosis of the wrist causing carpal tunnel syndrome in a patient with rheumatoid arthritis: A case report

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.

Genital tuberculosis, infertility and assisted reproduction

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.

Renal inflammatory myofibroblastic tumour presenting with a large retroperitoneal abscess

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.