1
|
Kaya A, Altınkaynak M, Keskin F, Özdemir G, Kaya SY, Mert A. Paradoxical psoas and subcutaneous abscesses developing on anti-tuberculous treatment: A case report and literature review. J Natl Med Assoc 2023; 115:392-397. [PMID: 37308345 DOI: 10.1016/j.jnma.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/08/2023] [Accepted: 05/15/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Abdurrahman Kaya
- Department of Infectious Diseases, İstanbul Training and Research Hospital, Istanbul, Turkey.
| | - Merve Altınkaynak
- Department of Infectious Diseases, İstanbul Training and Research Hospital, Istanbul, Turkey
| | - Feyza Keskin
- Department of Infectious Diseases, İstanbul Training and Research Hospital, Istanbul, Turkey
| | - Gülhan Özdemir
- Department of Infectious Diseases, İstanbul Training and Research Hospital, Istanbul, Turkey
| | - Sibel Yıldız Kaya
- Department of Infectious Diseases, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Turkey
| | - Ali Mert
- Infectious Diseases and Clinical Microbiology, Faculty of Medicine, İstanbul Medipol University, Turkey
| |
Collapse
|
2
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
3
|
Kassegne L, Bourgarit A, Fraisse P. [Parardoxical reaction following tuberculosis treatment in non HIV-infected patients]. Rev Mal Respir 2020; 37:399-411. [PMID: 32386802 DOI: 10.1016/j.rmr.2020.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 12/10/2019] [Indexed: 11/17/2022]
Abstract
A paradoxical reaction is the worsening of prior existing, or the appearance of, new tuberculous lesions, following the initiation of treatment with anti-tuberculous drugs, after the exclusion of poor compliance, malabsorption, drug interaction or multiresistant mycobacteria. Well known and well managed in the context of HIV coinfection, it is not well known outside this context. An increasing number of publications have described this syndrome. This review aims to describe the pathogenic, epidemiological, clinical, prognostic and therapeutic elements of non-HIV-associated paradoxical reactions. It involves a reversal of the Mycobacterium tuberculosis-induced immunodepression along with a heightened detrimental pro-inflammatory profile caused by efficient drug treatment. Extra-thoracic locations, especially lymph nodes and neurological, malnutrition and initial lymphopenia are the principal risk factors. The median delay is 40±20 days after the onset of treatment. Corticosteroids are the mainstay of the management. Anti-TNF-α drugs show good results in corticosteroid refractory cases. The prognosis is good overall except in neurological forms. The place of preventive methods remains to be established.
Collapse
Affiliation(s)
- L Kassegne
- Service de pneumologie, Nouvel hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'hôpital, 67000 Strasbourg cedex, France.
| | - A Bourgarit
- Université Paris 13, Bobigny, France; Service de médecine interne, hôpital Jean-Verdier, HUPSSD AP-HP, Bondy, France; Inserm U1135, centre d'immunologie et des maladies infectieuses, 75013 Paris, France
| | - P Fraisse
- Service de pneumologie, Nouvel hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'hôpital, 67000 Strasbourg cedex, France; Groupe pour l'enseignement et la recherche en pneumo-infectiologie de la SPLF, 66, boulevard Saint-Michel, 75006 Paris, France
| |
Collapse
|
4
|
Tokuyama Y, Matsumoto T, Kusakabe Y, Yamamoto N, Aihara K, Yamaoka S, Mishima M. Ground-glass opacity as a paradoxical reaction in miliary tuberculosis: A case report and review of the literature. IDCases 2020; 19:e00685. [PMID: 31908948 PMCID: PMC6939021 DOI: 10.1016/j.idcr.2019.e00685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/28/2019] [Accepted: 11/28/2019] [Indexed: 11/19/2022] Open
Abstract
A paradoxical reaction (PR) is an excessive immune response occurring during antitubercular therapy (ATT), but is rare in patients with miliary tuberculosis. A 78-year-old woman complained of general malaise, loss of appetite, and fever for 10 days. Chest computed tomography (CT) showed diffuse, bilateral, discrete miliary nodules. The patient was treated with ATT for miliary tuberculosis. Nine days after starting the treatment, she developed a spiking fever and worsening malaise. Repeat CT showed new localized ground-glass opacity (GGO) in the right upper lobe. After excluding possible etiologies, she was diagnosed with PR due to ATT. She was successfully managed with oral prednisolone while continuing ATT. The GGO diminished and did not recur after discontinuation of the steroids. We reviewed 28 reported cases of miliary tuberculosis with a PR in patients not infected with human immunodeficiency virus. Those not on immunosuppressive therapy were likely to develop a PR early. This case illustrates that a PR may present as localized GGO in miliary tuberculosis in the lung of patients treated with ATT. In cases of a PR with marked symptoms, steroid therapy may be valuable.
Collapse
Affiliation(s)
- Yuki Tokuyama
- Department of Respiratory Medicine, Saiseikai-Noe Hospital, Osaka, Japan
| | - Takeshi Matsumoto
- Department of Respiratory Medicine, Saiseikai-Noe Hospital, Osaka, Japan
| | - Yusuke Kusakabe
- Department of Respiratory Medicine, Saiseikai-Noe Hospital, Osaka, Japan
| | - Naoki Yamamoto
- Department of Respiratory Medicine, Saiseikai-Noe Hospital, Osaka, Japan
| | - Kensaku Aihara
- Department of Respiratory Medicine, Saiseikai-Noe Hospital, Osaka, Japan
| | - Shinpachi Yamaoka
- Department of Respiratory Medicine, Saiseikai-Noe Hospital, Osaka, Japan
| | - Michiaki Mishima
- Department of Respiratory Medicine, Saiseikai-Noe Hospital, Osaka, Japan
| |
Collapse
|
5
|
Abstract
Tuberculosis (TB) is still prevalent in many developing countries and can pose a new potential threat to global health due to international migration. As an uncommon form of extrapulmonary TB, cutaneous TB is complicated in its clinical manifestation, pathogenesis, and classification. Cutaneous TB can be divided into two major categories, true cutaneous TB and tuberculid, depending on the source of infection, the route of transmission, the amount of bacteria, and the immune state of the host. Clinical manifestations may include patches and plaques (lupus vulgaris, TB verrucosa cutis), macules and papules (acute miliary TB, papulonecrotid tuberculid, lichen scrofulosorum), nodules, and abscesses (erythema induratum of Bazin, tuberculous gumma), erosions, and ulcers (tuberculous chancre, orificial TB, scrofuloderma), mimicking diverse skin diseases. Uncommon localizations such as external genitalia, unusual presentations such as nodular granulomatous phlebitis, and coexistence with other morbidities such as Behçet disease and acne inversa or hidradenitis suppurativa deserve special attention. Treatment of both true and tuberculid cutaneous TB follows the same drug regimens of the World Health Organization's recommendation for treatment of new cases of pulmonary TB. Erythema induratum of Bazin may need longer treatment duration and adjuvants such as dapsone, potassium iodide, doxycycline, and corticosteroids to tackle inflammation. Misdiagnosis and undertreatment in daily practice are likely, and contemplation of this classic great imitator in dermatology is warranted.
Collapse
Affiliation(s)
- Qiquan Chen
- Department of Dermatology, Southwest Hospital, The Third Military Medical University, Chongqing, P.R. China
| | - WenChieh Chen
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany.
| | - Fei Hao
- Department of Dermatology, Southwest Hospital, The Third Military Medical University, Chongqing, P.R. China
| |
Collapse
|
6
|
Mert A, Arslan F, Kuyucu T, Koç EN, Yılmaz M, Turan D, Altın S, Pehlivanoglu F, Sengoz G, Yıldız D, Dokmetas I, Komur S, Kurtaran B, Demirdal T, Erdem HA, Sipahi OR, Batirel A, Parlak E, Tekin R, Tunçcan ÖG, Balkan II, Hayran O, Ceylan B. Miliary tuberculosis: Epidemiologicaland clinical analysis of large-case series from moderate to low tuberculosis endemic Country. Medicine (Baltimore) 2017; 96:e5875. [PMID: 28151863 PMCID: PMC5293426 DOI: 10.1097/md.0000000000005875] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to determine the clinical features, and outcome of the patients with miliary tuberculosis (TB).We retrospectively evaluated 263 patients (142 male, 121 female, mean age: 44 years, range: 16-89 years) with miliary TB. Criteria for the diagnosis of miliary TB were at least one of the followings in the presence of clinical presentation suggestive of miliary TB such as prolonged fever, night sweats, anorexia, weight loss: radiologic criterion and pathological criterion and/or microbiological criterion; pathological criterion and/or microbiological criterion.The miliary pattern was seen in 88% of the patients. Predisposing factors were found in 41% of the patients. Most frequent clinical features and laboratory findings were fever (100%), fatigue (91%), anorexia (85%), weight loss (66%), hepatomegaly (20%), splenomegaly (19%), choroid tubercules (8%), anemia (86%), pancytopenia (12%), and accelerated erythrocyte sedimentation rate (89%). Tuberculin skin test was positive in 29% of cases. Fifty percent of the patients met the criteria for fever of unknown origin. Acid-fast bacilli were demonstrated in 41% of patients (81/195), and cultures for Mycobacterium tuberculosis were positive in 51% (148/292) of tested specimens (predominantly sputum, CSF, and bronchial lavage). Blood cultures were positive in 20% (19/97). Granulomas in tissue samples of liver, lung, and bone marrow were present in 100% (21/21), 95% (18/19), and 82% (23/28), respectively. A total of 223 patients (85%) were given a quadruple anti-TB treatment. Forty-four (17%) patients died within 1 year after diagnosis established. Age, serum albumin, presence of military pattern, presence of mental changes, and hemoglobin concentration were found as independent predictors of mortality. Fever resolved within first 21 days in the majority (90%) of the cases.Miliary infiltrates on chest X-ray should raise the possibility of miliary TB especially in countries where TB is endemic. Although biopsy of the lungs and liver may have higher yield rate of organ involvement histopathologicaly, less invasive procedures including a bone marrow biopsy and blood cultures should be preferred owing to low complication rates.
Collapse
Affiliation(s)
- Ali Mert
- Department of Internal Medicine, Istanbul Medipol University
| | - Ferhat Arslan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University
| | - Tülin Kuyucu
- Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital
| | - Emine Nur Koç
- Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital
| | - Mesut Yılmaz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University
| | - Demet Turan
- Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Department of Chest Disease
| | - Sedat Altın
- Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Department of Chest Disease
| | - Filiz Pehlivanoglu
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital
| | - Gonul Sengoz
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital
| | - Dilek Yıldız
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul
| | - Ilyas Dokmetas
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul
| | - Suheyla Komur
- Department of Infectious Diseases and Clinical Microbiology, Cukurova University Medical Faculty, Adana
| | - Behice Kurtaran
- Department of Infectious Diseases and Clinical Microbiology, Cukurova University Medical Faculty, Adana
| | - Tuna Demirdal
- Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University
| | - Hüseyin A. Erdem
- Department of Infectious Diseases and Clinical Microbiology, Ege University, Izmir, Turkey
| | - Oguz Resat Sipahi
- Department of Infectious Diseases and Clinical Microbiology, Ege University, Izmir, Turkey
| | - Ayse Batirel
- Department of Infectious Diseases and Clinical Microbiology, LutfiKirdar Training and Research Hospital, Istanbul, Turkey
| | - Emine Parlak
- Department of Infectious Diseases and Clinical Microbiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Recep Tekin
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Özlem Güzel Tunçcan
- Department of Clinical Microbiology and Infectious Diseases, Gazi University Hospital, Ankara, Turkey
| | - Ilker Inanc Balkan
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Osman Hayran
- Faculty of Medicine, Department of Public Health, Medipol University, Istanbul, Turkey
| | - Bahadır Ceylan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, Istanbul, Turkey
| |
Collapse
|
7
|
Pornsuriyasak P, Suwatanapongched T. Thoracic manifestations of paradoxical immune reconstitution inflammatory syndrome during or after antituberculous therapy in HIV-negative patients. Diagn Interv Radiol 2016; 21:134-9. [PMID: 25698091 DOI: 10.5152/dir.2014.14212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Immune reconstitution inflammatory syndrome (IRIS) is a consequence of exaggerated and dysregulated host's inflammatory response to invading microorganism, leading to uncontrolled inflammatory reactions. IRIS associated with tuberculosis (TB) is well recognized among human immunodeficiency virus (HIV)-infected patients receiving highly active antiretroviral therapy, but it is less common among HIV-negative patients. IRIS can manifest as a paradoxical worsening or recurring of preexisting tuberculous lesions or development of new lesions despite successful antituberculous treatment. Hence, the condition might be misdiagnosed as superimposed infections, treatment failure, or relapse of TB. This pictorial essay reviewed diagnostic criteria and various thoracic manifestations of the paradoxical form of TB-associated IRIS (TB-IRIS) that might aid in early recognition of this clinical entity among HIV-negative patients. The treatment and outcomes of TB-IRIS were also discussed.
Collapse
Affiliation(s)
- Prapaporn Pornsuriyasak
- Division of Pulmonary and Critical Care, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok.
| | | |
Collapse
|
8
|
Affiliation(s)
- Donald E. Fry
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and the Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| |
Collapse
|
9
|
Lanzafame M, Vento S. Tuberculosis-immune reconstitution inflammatory syndrome. J Clin Tuberc Other Mycobact Dis 2016; 3:6-9. [PMID: 31723680 PMCID: PMC6850228 DOI: 10.1016/j.jctube.2016.03.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 02/26/2016] [Accepted: 03/04/2016] [Indexed: 12/24/2022] Open
Abstract
Tuberculosis-immune reconstitution inflammatory syndrome is an excessive immune response against Mycobacterium tuberculosis that may occur in either HIV-infected or uninfected patients, during or after completion of anti-TB therapy. In HIV-infected patients it occurs after initiation of antiretroviral therapy independently from an effective suppression of HIV viremia. There are two forms of IRIS: paradoxical or unmasking. Paradoxical IRIS is characterized by recurrent, new, or worsening symptoms of a treated case. Unmasking IRIS is an antiretroviral-associated inflammatory manifestation of a subclinical infection with a hastened presentation. The pathogenesis is incompletely understood and the epidemiology partially described. No specific tests can establish or rule out the diagnosis. Treatment is based on the use of anti-tuberculosis drugs sometime with adjunctive corticosteroids. Mortality is generally low.
Collapse
Affiliation(s)
| | - Sandro Vento
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| |
Collapse
|
10
|
Santesteban R, Bonaut B, Córdoba A, Yanguas I. Paradoxical reaction to antituberculosis therapy in a patient with lupus vulgaris. Actas Dermosifiliogr 2015; 106:e7-e12. [PMID: 25089032 DOI: 10.1016/j.ad.2014.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 04/15/2014] [Accepted: 05/11/2014] [Indexed: 11/21/2022] Open
Abstract
Patients receiving treatment for tuberculosis may experience an unexpected deterioration of their disease; this is known as a paradoxical reaction. We present the case of a 59-year-old man with lupus vulgaris who experienced a paradoxical deterioration of cutaneous lesions after starting antituberculosis therapy. The reaction was self-limiting; the lesions gradually improved, and the final outcome was very good. Paradoxical reactions are well-known in patients with human immunodeficiency virus (HIV) infection who start antiretroviral therapy, but they can also occur in non-HIV-infected patients with tuberculosis who start antituberculosis therapy. In the literature reviewed, paradoxical reactions involving skin lesions were described in patients with miliary tuberculosis. The case we report is the first of a paradoxical reaction in lupus vulgaris. The increasing frequency of tuberculosis in Spain could lead to a rise in the number of paradoxical reactions.
Collapse
|
11
|
Santesteban R, Bonaut B, Córdoba A, Yanguas I. Paradoxical Reaction to Antituberculosis Therapy in a Patient With Lupus Vulgaris. Actas Dermo-Sifiliográficas (English Edition) 2015; 106:e7-e12. [DOI: 10.1016/j.adengl.2014.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
12
|
Melwani PM, Hernández-Machín B, Borrego L, Peñate Y. Paradoxical response during antituberculosis therapy in a patient with tuberculosis verrucosa cutis. J Am Acad Dermatol 2011; 65:e53-e54. [PMID: 21763552 DOI: 10.1016/j.jaad.2010.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 11/02/2010] [Accepted: 11/06/2010] [Indexed: 11/18/2022]
Affiliation(s)
- Priti M Melwani
- Department of Dermatology, Hospital Universitario Insular de Gran Canaria, Spain.
| | | | - Leopoldo Borrego
- Department of Dermatology, Hospital Universitario Insular de Gran Canaria, Spain
| | - Yeray Peñate
- Department of Dermatology, Hospital Universitario Insular de Gran Canaria, Spain
| |
Collapse
|
13
|
Fernández-Fúnez Á. Respuesta paradójica durante el tratamiento tuberculostático en pacientes inmunocompetentes. Med Clin (Barc) 2009; 133:637-43. [DOI: 10.1016/j.medcli.2008.12.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 12/18/2008] [Indexed: 11/28/2022]
|
14
|
Soualhi M, Iraqi G, Belkheiri S, Zahraoui R, Chaibainou A, Benamour J, Eddine Bourkadi J. Tuberculose multi-focale (palpébrale et pleurale) chez une immunocompétente. Rev Mal Respir 2006; 23:281-4. [PMID: 16788531 DOI: 10.1016/s0761-8425(06)71580-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Tuberculosis of the eyelid and its development in the setting of multifocal tuberculosis is exceptionally rare. CASE REPORT The authors report a new observation of multifocal tuberculosis in a non-immunosuppressed woman of 28 years with histologically confirmed pleural and palpebral involvement. A paradoxical reaction was seen following the initiation of anti-tuberculous treatment with appearance of new manifestations (thoracic cold abscesses). CONCLUSION The authors draw attention to this rare localisation and to the paradoxical reactions during treatment, emphasising the need for early diagnosis to avoid local and remote complications.
Collapse
Affiliation(s)
- M Soualhi
- Service de maladies respiratoires, Hôpital Universitaire Moulay Youssef, Rabat, Maroc.
| | | | | | | | | | | | | |
Collapse
|
15
|
Khosrovaneh A, Camero LG, Briski LE, Khatib R. Chest wall soft tissue tuberculosis: a protracted course over a 10-year period. ACTA ACUST UNITED AC 2006; 38:129-30. [PMID: 16449006 DOI: 10.1080/00365540500277243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Amir Khosrovaneh
- Department of Medicine, St John Hospital & Medical Center, Detroit, Michigan, USA
| | | | | | | |
Collapse
|
16
|
Abstract
The decreased incidence of infectious diseases in developed countries may make their diagnosis difficult. Cutaneous tuberculosis is an example of this fact. A 44-year-old man presented with two painful abscesses on his lower extremities, which developed into chronic ulcers. A cutaneous biopsy revealed necrotizing granulomas in the dermis. Ziehl-Neelsen and periodic acid-Schiff stain were negative. Mantoux test was positive. Tc-99m scintigraphy showed increased uptake in the bone tissue of the left ankle and right tibiae, without direct relation to cutaneous lesions. Chest X-ray showed micronodular, apical, bilateral infiltrates, reduced volume of the right lung, and cavitation of the right superior lobe. Mycobacterium tuberculosis was grown from sputum and skin biopsy samples. Isoniazid, rifampin and pyrazinamide treatment for 2 months, followed by isoniazid and rifampin for 12 months, resulted in complete resolution. The clinical features of cutaneous tuberculosis in our patient were characteristic of tuberculous abscesses. Some uncommon findings, such as the low number of lesions, negative acid-fast resistant stains in cutaneous biopsy samples and his preserved general state of health, may be explained by a higher competence of the immune system than is usual in this clinical subset of disseminated tuberculosis. Cutaneous tuberculosis should be included in the differential diagnosis of cutaneous abscesses in immunocompetent patients.
Collapse
Affiliation(s)
- M Almagro
- Department of Dermatology, Hospital Juan Canalejo, A Coruna, Spain
| | | | | | | | | | | |
Collapse
|
17
|
|
18
|
Mert A, Ozaras R. Cutaneous tuberculosis from paradoxical expansion: a new category in the classification of cutaneous tuberculosis. Scand J Infect Dis 2002; 33:945. [PMID: 11868776 DOI: 10.1080/00365540110077100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
19
|
Cheng VCC, Yuen KY. Reply. Clin Infect Dis 2001. [DOI: 10.1086/319233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|