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Pakhan AA, Raghumahanti R. Targeted Six-Week Intensive Physiotherapy for a Case of Tuberculous Meningitis With a Syndrome of Inappropriate Antidiuretic Hormone Secretion. Cureus 2024; 16:e55214. [PMID: 38558619 PMCID: PMC10981514 DOI: 10.7759/cureus.55214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis (TB) characterized by the invasion of Mycobacterium tuberculosis into the meninges surrounding the brain and spinal cord. It triggers an intense inflammatory response, leading to neurological complications if not promptly and adequately managed. TBM often precipitates muscle weakness, neurological deficits, respiratory challenges, swallowing difficulties, joint contractures, and pain. Physiotherapy intervention is essential in treating these problems by personalized treatment strategies and treatment plans to enhance muscle strength, motor control, coordination, and overall mobility. This case report aims to highlight the significant role of physiotherapy in improving the quality of life (QOL) and functional abilities of patients with TBM. The current case report reviews the case of a 73-year-old male who presented with complaints of generalized weakness and difficulty in swallowing. The patient had a history of fever for the last six months. Magnetic resonance imaging (MRI) and high-resolution computed tomography (HRCT) diagnosed the case as TBM with miliary TB. Six weeks of targeted intensive rehabilitation program was designed according to the patient's impairments initiated from the intensive care unit (ICU) phase. The main goals of physiotherapy were to start early bed mobility, maintain joint integrity, improve postural strength and swallowing, and make the patient independent in transfer and activities of daily living (ADLs). After a six-week intensive physiotherapy (TIP-6) program, the patient exhibited significant improvements in muscle strength and independence in ADLs. This case highlights the critical role of physiotherapy in enhancing the QOL and functional abilities of patients with severe TB-related conditions.
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Affiliation(s)
- Arjavi A Pakhan
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raghuveer Raghumahanti
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Li X, Wang Y, Zhang B, Jia X, Mu L, Ke J. Acute lupus pneumonitis resembling miliary tuberculosis: A case-based review. Open Life Sci 2023; 18:20220751. [PMID: 38196517 PMCID: PMC10775172 DOI: 10.1515/biol-2022-0751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/19/2023] [Accepted: 09/11/2023] [Indexed: 01/11/2024] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple systems and organs, with pulmonary involvement known to be associated with disease prognosis and mortality. Acute lupus pneumonitis (ALP) resembling miliary tuberculosis (TB) is rare. Here, we present a case of ALP mimicking miliary TB and review the literature. A 19-year-old male student was referred to our hospital with fever. Although the patient met the diagnostic criteria for SLE, diffuse miliary nodules in both lungs were observed on a chest computed tomography scan. A series of tests, including pathological testing of bronchoscopy brushes, T-lymphocyte culture + interferon assay (A + B), tuberculin test, detection of mycobacterium TB DNA, and acid-fast bacilli smear in bronchoalveolar lavage fluid, were unable to confirm the presence of TB infection. We considered the patient to have ALP. After beginning ALP therapy, his symptoms disappeared, and the imaging and hematological results returned to normal. Miliary TB and ALP have similar clinical manifestations and imaging changes, which make diagnosis difficult. This case highlights the need to ensure accurate diagnosis and treatment to improve prognosis.
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Affiliation(s)
- Xin Li
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
| | - Yuan Wang
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
| | - Baoyu Zhang
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
| | - Xiaoxia Jia
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
| | - Lin Mu
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
| | - Jing Ke
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
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Allahverdi Nazhand H, Sabeti S, Javandoust Gharehbagh F, Nalini R, Babamahmoodi A, Marahemi M, Mahmoudi Chalmiani E, Lotfollahi L, Alavi Darazam I. Undiagnosed tuberculosis associated with hemophagocytic lymphohistiocytosis due to improper use of corticosteroid. J Infect Dev Ctries 2023; 17:1647-1653. [PMID: 38064397 DOI: 10.3855/jidc.17303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/28/2022] [Accepted: 03/22/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening hematologic disease segregated into familial (primary) and acquired (secondary) subtypes. Hyperinflammation and HLH occur when the immune system fails to clear activated macrophages and histiocytes. Infections, malignancies, and rheumatologic disorders are the major triggers leading to HLH. Miliary tuberculosis is a serious disease with a lymphohematogenous spread of Mycobacterium tuberculosis, which is known to be one of the causative agents of HLH. Miliary tuberculosis and HLH have atypical presentations which are similar to routine diseases. Hence, physicians may face challenges to diagnose and treat these complications. CASE REPORT We report the case of a 60-year-old man with a history of prolonged fever, shortness of breath, jaundice, altered mental status, undiagnosed lower back pain, and overuse of parenteral betamethasone. Miliary tuberculosis was diagnosed by diffuse, vague random micronodules in both lungs and positive acid-fast bacilli in bronchoalveolar lavage and bone marrow aspiration and biopsy. Moreover, compatible presentation and pancytopenia, hypertriglyceridemia, high serum level of ferritin and fibrinogen-derived products, and evidence of hemophagocytosis on bone marrow aspirate led to the diagnosis of HLH. Unfortunately, despite nearly two months of an anti-tuberculosis regimen (standard and salvage) and eight doses of etoposide, he eventually passed away after clinical improvement. CONCLUSIONS Irrational and indiscriminate use of glucocorticoids can be a devastating cause of the spread of tuberculosis and its rare complications, such as HLH.
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Affiliation(s)
- Hadi Allahverdi Nazhand
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Sabeti
- Pathology Ward, Loghman Hakim hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Javandoust Gharehbagh
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ronak Nalini
- Department of Hematology and Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdolreza Babamahmoodi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Marahemi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elmira Mahmoudi Chalmiani
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Legha Lotfollahi
- Department of Nephrology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zhu J, Chen N, Shang Y, Feng Y. Case report: Miliary tuberculosis complicated by pediatric acute respiratory distress syndrome in a 12-year-old girl. Front Pediatr 2023; 11:1189838. [PMID: 37732009 PMCID: PMC10507688 DOI: 10.3389/fped.2023.1189838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a rare complication of miliary tuberculosis, particularly in pediatric patients. Comorbidities and delayed diagnosis can worsen the prognosis of patients with miliary tuberculosis. A 12-year-old girl presented with fever for 20 days, and cough and tachypnea for 4 days. She was diagnosed with miliary tuberculosis complicated by pediatric ARDS. She had atypical clinical manifestations and imaging findings, a negative contact history, and negative results of a tuberculin skin test (TST) and T-SPOT.TB. Diagnostic bronchoscopy and bronchoalveolar lavage helped make the diagnosis of tuberculosis. Effective treatment was promptly initiated after confirmation of the diagnosis, and the patient's condition improved. This case illustrates that a negative contact history and laboratory results cannot rule out tuberculosis. False-negative TST and T-SPOT.TB results should be evaluated carefully. Bronchoscopy may be useful for identifying pathogens in patients with pneumonia of unknown etiology, and corticosteroids should be administered with caution.
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Affiliation(s)
| | | | | | - Yong Feng
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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Song W, Liu S, Yu Y, Xu Q, Liu S, Chen J. Lung metastasis from thyroid cancer: A case report of unusual imaging presentation of lung metastases. Medicine (Baltimore) 2023; 102:e34733. [PMID: 37565894 PMCID: PMC10419426 DOI: 10.1097/md.0000000000034733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023] Open
Abstract
RATIONALE Thyroid cancer (TC) is the most common malignancy of the head and neck and endocrine system. Distant metastases from TC are rare and are diagnosed in only 1% to 4% of patients, and these patients have a poor prognosis, which is the leading cause of TC-related deaths. There are few reports on metastatic TC in China and abroad, and even fewer reports on lung metastases from TC. We report a special patient with lung metastases of TC. PATIENT CONCERNS The patient is a 31-year-old female who was found to have both lung nodules during physical examination. Chest computed tomography (CT) showed that the density of both lung nodules was the same as the vascular density, considering that the possibility of vascular origin was not excluded. DIAGNOSIS After consultation with the whole hospital, it was considered that vascular malformations, hemangiomas, and malignant metastases were not excluded, the patient percutaneous lung biopsy had a high risk of bleeding, and thoracoscopic lobectomy could be performed in thoracic surgery to further clarify the pathology and diagnosis. OUTCOMES The patient underwent thoracoscopic left lower lobe wedge resection on February 24, 2021. Postoperative pathology: (left lower lung mass) metastatic carcinoma, combined with morphology and immunohistochemistry, leaning toward thyroid follicular carcinoma lung metastasis. On May 27, 2021, the patient underwent "total thyroidectomy + lymph node dissection in the right cervical VI region." Pathological examination: (right lobe and isthmus of the thyroid gland) papillary TC, follicular subtype, and classic type, with interstitial fibrosis. The patient was diagnosed with lung metastasis of TC. LESSONS This patient had the same CT value of lung metastases as the vascular CT value, which is relatively rare in our clinical practice and worthy of our study. The special CT imaging presentation of this TC patient with lung metastases further broadened our horizon. In clinical practice, when we encounter similar cases, we should combine more with other tests and examinations of patients to avoid misdiagnosis and missed diagnosis.
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Affiliation(s)
- Wenjing Song
- Medical Oncology, Dalian Medical University, Dalian, Liaoning, China
- Oncology Department, the First Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Shiwei Liu
- Joint surgery Department, the First Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Yuan Yu
- Oncology Department, the First Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Qian Xu
- Oncology Department, the First Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Shuzhen Liu
- Oncology Department, the First Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Jun Chen
- Medical Oncology, the Second Hospital of Dalian Medical University, Dalian, Liaoning, China
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Patel PB, Purohit B. A Very Unusual Presentation of Miliary Tuberculosis and Osteomyelitis as an Incidental Finding of Musculoskeletal Pain. Cureus 2023; 15:e44207. [PMID: 37719505 PMCID: PMC10501806 DOI: 10.7759/cureus.44207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 09/19/2023] Open
Abstract
Tuberculosis (TB) is a highly infectious disease that takes the primary or latent route. In primary TB, the patient often presents with constitutional symptoms such as cough, fever, weight loss, and hemoptysis. This 83-year-old patient was sent to the emergency department (ED) by her primary care physician after abnormal imaging for acute back and neck pain. Imaging revealed pulmonary TB with possible tuberculosis osteomyelitis versus metastatic carcinoma to the cervical vertebrae. The case's unique presentation gives light to the need for more research on miliary TB and tuberculosis spondylitis/osteomyelitis in various populations and circumstances to ensure prompt and adequate patient care.
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Affiliation(s)
- Prachi B Patel
- Internal Medicine, Philadelphia College of Osteopathic Medicine, Atlanta, USA
| | - Bhavi Purohit
- Internal Medicine, Wellstar North Fulton Hospital, Roswell, USA
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Subedi RC, Acharya S, Adhikari A, Banmala S, Shiwakoti TK, Karki P, Gurung S, Bhatta B, Kharbuja N, Paudel R. Disseminated tuberculosis in an immunocompetent woman from the Himalayan region of Nepal: A case report. Clin Case Rep 2023; 11:e7754. [PMID: 37546164 PMCID: PMC10397472 DOI: 10.1002/ccr3.7754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/06/2023] [Revised: 07/04/2023] [Accepted: 07/16/2023] [Indexed: 08/08/2023] Open
Abstract
Disseminated tuberculosis (TB) resulting from lymphohematogenous dissemination of Mycobacterium tuberculosis during primary infection or reactivation of latent disease is rare among young immunocompetent patients. Central nervous system TB (CNS TB) is one of the most challenging clinical diagnoses with high fatality. Here, we describe a young immunocompetent female with no known comorbidities initially presented with military pulmonary TB and later developed CNS TB. This presentation of disseminated TB in immunocompetent patient warrant early diagnosis and treatment.
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Affiliation(s)
| | - Subi Acharya
- Department of PediatricsPatan Academy of Health SciencesLalitpurNepal
| | - Ayush Adhikari
- Department of Anesthesia and Critical CareTribhuvan University Teaching HospitalKathmanduNepal
| | - Sabin Banmala
- Department of Emergency MedicineSindhuli HospitalSindhuliNepal
| | - Tibbin Kumar Shiwakoti
- Department of General Practice and Emergency MedicineKarnali Academy of Health SciencesJumlaNepal
| | | | - Shekhar Gurung
- Department of Emergency MedicineChattarapati Free Health Clinic Community HospitalKathmanduNepal
| | - Bhuwan Bhatta
- Department of Internal MedicineKantipur HospitalKathmanduNepal
| | - Naresh Kharbuja
- Department of NeurologyGrande International HospitalKathmanduNepal
| | - Raju Paudel
- Department of NeurologyGrande International HospitalKathmanduNepal
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8
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Chiang SS, Graham SM, Schaaf HS, Marais BJ, Sant'Anna CC, Sharma S, Starke JR, Triasih R, Achar J, Amanullah F, Armitage LY, Aurilio RB, Buck WC, Centis R, Chabala C, Cruz AT, Demers AM, du Preez K, Enimil A, Furin J, Garcia-Prats AJ, Gonzalez NE, Hoddinott G, Isaakidis P, Jaganath D, Kabra SK, Kampmann B, Kay A, Kitai I, Lopez-Varela E, Maleche-Obimbo E, Malaspina FM, Velásquez JN, Nuttall JJC, Oliwa JN, Andrade IO, Perez-Velez CM, Rabie H, Seddon JA, Sekadde MP, Shen A, Skrahina A, Soriano-Arandes A, Steenhoff AP, Tebruegge M, Tovar MA, Tsogt B, van der Zalm MM, Welch H, Migliori GB. Clinical standards for drug-susceptible TB in children and adolescents. Int J Tuberc Lung Dis 2023; 27:584-598. [PMID: 37491754 PMCID: PMC10365562 DOI: 10.5588/ijtld.23.0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND: These clinical standards aim to provide guidance for diagnosis, treatment, and management of drug-susceptible TB in children and adolescents.METHODS: Fifty-two global experts in paediatric TB participated in a Delphi consensus process. After eight rounds of revisions, 51/52 (98%) participants endorsed the final document.RESULTS: Eight standards were identified: Standard 1, Age and developmental stage are critical considerations in the assessment and management of TB; Standard 2, Children and adolescents with symptoms and signs of TB disease should undergo prompt evaluation, and diagnosis and treatment initiation should not depend on microbiological confirmation; Standard 3, Treatment initiation is particularly urgent in children and adolescents with presumptive TB meningitis and disseminated (miliary) TB; Standard 4, Children and adolescents should be treated with an appropriate weight-based regimen; Standard 5, Treating TB infection (TBI) is important to prevent disease; Standard 6, Children and adolescents should receive home-based/community-based treatment support whenever possible; Standard 7, Children, adolescents, and their families should be provided age-appropriate support to optimise engagement in care and clinical outcomes; and Standard 8, Case reporting and contact tracing should be conducted for each child and adolescent.CONCLUSION: These consensus-based clinical standards, which should be adapted to local contexts, will improve the care of children and adolescents affected by TB.
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Affiliation(s)
- S S Chiang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, Center for International Health Research, Rhode Island Hospital, Providence, RI, USA
| | - S M Graham
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Burnet Institute, Melbourne, VIC, Australia
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - B J Marais
- Department of Paediatrics and Child Health and the Sydney Infectious Diseases Institute (Sydney ID), Sydney, NSW, Department of Infectious Diseases, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - C C Sant'Anna
- Department of Paediatrics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - S Sharma
- Department of Paediatrics, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - J R Starke
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, Section of Infectious Diseases, Texas Children's Hospital, Houston, TX, USA
| | - R Triasih
- Department of Paediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - J Achar
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - F Amanullah
- Department of Paediatrics, The Indus Hospital and Health Network, Karachi, Department of Paediatrics, The Aga Khan University Hospital, Karachi, Pakistan
| | - L Y Armitage
- Heartland National TB Center, University of Texas Health Science Center at Tyler, San Antonio, TX, USA
| | - R B Aurilio
- Department of Paediatrics, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Department of Paediatrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - W C Buck
- Department of Pediatrics, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - R Centis
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Italy
| | - C Chabala
- School of Medicine, Department of Paediatrics and Child Health, University of Zambia, Lusaka, Children's Hospital, University Teaching Hospitals, Lusaka, Zambia
| | - A T Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - A-M Demers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Division of Microbiology, Department of Laboratory Medicine, CHU Sainte-Justine, Montreal, Canada
| | - K du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A Enimil
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, Division of Infectious Diseases, Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA
| | - N E Gonzalez
- División Neumotisiología, Hospital de Niños Pedro de Elizalde, Buenos Aires, Dirección General de Posgrado, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - P Isaakidis
- Southern Africa Medical Unit (SAMU), Médecins Sans Frontières, Cape Town, South Africa, Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - D Jaganath
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - S K Kabra
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - B Kampmann
- Charite Centre for Global Health, Charite Universitatsmedizin Berlin, Berlin, Germany, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - A Kay
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - I Kitai
- Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - E Lopez-Varela
- Hospital Clínic and ISGlobal, Universitat de Barcelona, Barcelona, Spain, Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - E Maleche-Obimbo
- Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya
| | - F Mestanza Malaspina
- Department of Paediatrics, Hospital San Bartólome, Lima, Red Peruana de Tuberculosis Pediátrica, Dirección de Prevención y Control de Tuberculosis, Ministerio de Salud, Lima, Perú
| | - J Niederbacher Velásquez
- Department of Paediatrics, Universidad Industrial de Santander, Bucaramanga, Board of Directors, Asociación Colombiana de Neumología Pediátrica, Bogotá, Colombia
| | - J J C Nuttall
- Paediatric Infectious Diseases Unit, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - J N Oliwa
- Faculty of Health Sciences, Department of Paediatrics and Child Health, The University of Nairobi, Nairobi, Health Services Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - I Orozco Andrade
- Center of Diagnosis and Integral Treatment for Tuberculosis, Servicios Médicos de la Frontera, Juárez, Medical Coordination, Juntos Binational Tuberculosis Project, Juárez, México
| | - C M Perez-Velez
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - H Rabie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Infectious Disease, Imperial College London, London, UK
| | - M P Sekadde
- National TB and Leprosy Program, Ministry of Health, Kampala, Uganda
| | - A Shen
- Beijing Paediatric Research Institute, National Centre for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, Pediatric Research Institute, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - A Skrahina
- Clinical Department, The Republican Scientific and Practical Centre for Pulmonology and TB, Minsk, Belarus
| | - A Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Infection and Immunity in Children, Vall d'Hebron Research Institute, Barcelona, Spain
| | - A P Steenhoff
- Global Health Center and Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA, Department of Paediatric & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - M Tebruegge
- Department of Infection, Immunity & Inflammation, University College London, Great Ormond Street Institute of Child Health, London, UK, Department of Paediatrics, Klinik Ottakring, Wiener Gesundheitsverbund, Vienna, Austria
| | - M A Tovar
- Socios En Salud Sucursal Perú, Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - B Tsogt
- Research and Innovation, Mongolian Anti-TB Coalition, Ulaanbaatar, Mongolia
| | - M M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - H Welch
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, Department of Paediatrics, The University of Papua New Guinea School of Medicine and Health Sciences, Port Moresby, Papua New Guinea
| | - G B Migliori
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Italy
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M S, Yelne S, Chaudhary M, Agrawal A. Unveiling the Silent Invader: A Case Report on Miliary Tuberculosis. Cureus 2023; 15:e41817. [PMID: 37575864 PMCID: PMC10423064 DOI: 10.7759/cureus.41817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Miliary tuberculosis (TB) is characterized by the spreading of Mycobacterium tuberculosis throughout the body, leading to various clinical manifestations and potential complications. This case involves a 58-year-old male who presented with fever, night sweats, weight loss, and respiratory symptoms. Diagnostic workup revealed the characteristic radiological findings of diffuse miliary nodules on CT scan and X-ray of the chest. Laboratory investigations, including a positive interferon-gamma release assay, supported the diagnosis. The patient was initiated on a multidrug anti-TB regimen consisting of rifampicin, isoniazid, pyrazinamide, and ethambutol, with adjunctive corticosteroids for severe manifestations. Close monitoring and supportive care were provided. The patient started anti-TB therapy and his health improved significantly. He was able to receive a kidney transplant successfully. The case report emphasizes the importance of early recognition, timely diagnosis, and appropriate treatment initiation to improve patient outcomes.
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Affiliation(s)
- Spandana M
- Paediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Seema Yelne
- Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Minakshi Chaudhary
- Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Resesrach, Wardha, IND
| | - Aman Agrawal
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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10
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Okuma T, Mizushima R, Takeda Y, Toriyama K, Watanabe Y, Nakamura H, Aoshiba K. Pulmonary miliary sarcoidosis masquerading the reactivation of tuberculosis 30 years later. Clin Case Rep 2023; 11:e7624. [PMID: 37361660 PMCID: PMC10290199 DOI: 10.1002/ccr3.7624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/21/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023] Open
Abstract
Key Clinical Message Sarcoidosis may occur after treatment with pulmonary tuberculosis and requires differential diagnosis from tuberculosis reactivation. Miliary sarcoidosis should be promptly differentiated from miliary tuberculosis associated with high mortality. Abstract Clinical, histological, and radiological similarities between sarcoidosis and tuberculosis render differential diagnosis challenging. The association between these two diseases has long been discussed, although the coexistence or subsequent occurrence of tuberculosis and sarcoidosis is rare. We report a case of miliary sarcoidosis that developed 30 years after tuberculous pleurisy treatment. Sarcoidosis may occur after treatment with pulmonary tuberculosis and requires differential diagnosis from tuberculosis reactivation. Although miliary sarcoidosis is uncommon, it should be promptly differentiated from miliary tuberculosis associated with high mortality. This study reignites the debate on the causal association between tuberculosis and sarcoidosis.
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Affiliation(s)
- Takashi Okuma
- Department of Respiratory MedicineTokyo Medical University Ibaraki Medical CenterIbarakiJapan
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Reimi Mizushima
- Department of Respiratory MedicineTokyo Medical University Ibaraki Medical CenterIbarakiJapan
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Yukihisa Takeda
- Department of Respiratory MedicineTokyo Medical University Ibaraki Medical CenterIbarakiJapan
| | - Kazutoshi Toriyama
- Department of Respiratory MedicineTokyo Medical University Ibaraki Medical CenterIbarakiJapan
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Yusuke Watanabe
- Department of Respiratory MedicineTokyo Medical University Ibaraki Medical CenterIbarakiJapan
- Department of Infection Prevention and ControlTokyo Medical University HospitalTokyoJapan
| | - Hiroyuki Nakamura
- Department of Respiratory MedicineTokyo Medical University Ibaraki Medical CenterIbarakiJapan
| | - Kazutetsu Aoshiba
- Department of Respiratory MedicineTokyo Medical University Ibaraki Medical CenterIbarakiJapan
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11
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Paul SK, Ahmed S, Chakrabortty R, Paul SK, Rahman MA. Miliary tuberculosis in an immune-competent Bangladeshi man-A case report. Clin Case Rep 2023; 11:e7516. [PMID: 37305888 PMCID: PMC10256868 DOI: 10.1002/ccr3.7516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/13/2022] [Revised: 03/11/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023] Open
Abstract
Miliary tuberculosis is a disseminated and active form of tuberculosis caused by Mycobacterium tuberculosis. It frequently affects immunocompromised patients. However, immune-competent hosts are reported rarely. Herein, we reported a case of miliary tuberculosis of a 40-year-old immune-competent Bangladeshi man presented with pyrexia of unknown origin.
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Affiliation(s)
- Susanta Kumar Paul
- Department of Respiratory MedicineBangabandhu Sheikh Mujib Medical UniversityDhakaBangladesh
| | - Shamim Ahmed
- Department of Respiratory MedicineBangabandhu Sheikh Mujib Medical UniversityDhakaBangladesh
| | - Rajashish Chakrabortty
- Department of Respiratory MedicineBangabandhu Sheikh Mujib Medical UniversityDhakaBangladesh
| | - Shamrat Kumar Paul
- Department of Physics and AstronomyClemson UniversityClemsonSouth CarolinaUSA
| | - Mohammed Atiqur Rahman
- Department of Respiratory MedicineBangabandhu Sheikh Mujib Medical UniversityDhakaBangladesh
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12
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Labbad I, Hamzeh G. Cerebral venous thrombosis and miliary tuberculosis: a case report from Syria. Ann Med Surg (Lond) 2023; 85:2190-2193. [PMID: 37229017 PMCID: PMC10205188 DOI: 10.1097/ms9.0000000000000652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/25/2023] [Accepted: 04/02/2023] [Indexed: 05/27/2023] Open
Abstract
Cerebral venous thrombosis (CVT) is a relatively common disease. Risk factors for CVT include pregnancy, cancer, autoimmune diseases, and hypercoagulation. Acute and chronic meningitis are also considered predisposing conditions for CVT. Cases of CVT associated with tuberculous meningitis and miliary tuberculosis (TB) are rare in the medical literature, and here the authors report the first case report from Middle East. Case presentation The authors present a 33-year-old female patient diagnosed initially with CVT to discover the presence of tuberculous meningitis and miliary TB. Clinical discussion CVT is an urgent condition and the outcome is usually good when treated quickly. The mechanisms of TB causing thrombosis are endothelial injury, slow venous flow, and increased platelet aggregation. The clinical presentation of CVT can be confused and falsely attributed to TB Meningitis. Conclusion Infectious causes of CVT should always be remembered, especially TB should be in mind in developing countries.
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Affiliation(s)
- Ibrahim Labbad
- Corresponding author. Address: Damascus University, Damascus, 97089, Syrian Arab Republic. Tel.: 00963988532628. E-mail address: (I. Labbad)
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13
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Seifi A, Shafiee N, Moradi M. Pulmonary adenocarcinoma mimicking miliary tuberculosis in a 20-year-old man: A clinical case report. Clin Case Rep 2023; 11:e7028. [PMID: 36873069 PMCID: PMC9981568 DOI: 10.1002/ccr3.7028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/06/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Lung adenocarcinoma (LA) is the most common subtype of lung cancer with nonsignificant manifestations. Some benign conditions can mimic LA in symptoms and even chest imaging. In this case report, we are discussing a young man without any significant medical history with metastatic LA, initially presumed military TB.
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Affiliation(s)
- Arash Seifi
- Department of infectious diseases, Imam Khomeini Hospital Tehran University of Medical Sciences Tehran Iran
| | - Nahid Shafiee
- Department of infectious diseases, Imam Khomeini Hospital Tehran University of Medical Sciences Tehran Iran
| | - Maryam Moradi
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital Iran University of Medical Sciences Tehran Iran
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14
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Ghanta PR, Phatak SV, Parihar PS, Dhande RP, Reddy NG. Radiological Evaluation of a Rare Case of Rib Caries and Cold Abscess in a Young Male Patient With Miliary Tuberculosis: A Case Report With Review of Literature. Cureus 2023; 15:e35075. [PMID: 36942180 PMCID: PMC10024632 DOI: 10.7759/cureus.35075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Rib caries with a cold abscess is a rare presentation of tuberculosis (TB) and is tricky to diagnose. It is rarer in young patients, especially in conjunction with active miliary TB. We present one such case of a 23-year-old male patient who presented with swelling over the left lower chest. Rib caries and cold abscess were initially detected by ultrasonography and elastography. The rib involvement and the extent of the cold abscess were further evaluated on a computed tomography scan, which also showed active pulmonary miliary TB. The patient was treated by aspiration of the cold abscess and anti-tuberculosis therapy. The fact that the patient had no history of diabetes, alcoholism, human immunodeficiency virus infection, or immunodeficiency disorder increases the rarity of this case. This case highlights the role of imaging in diagnosing rib caries, cold abscess, and miliary TB.
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Affiliation(s)
- Prasanthi R Ghanta
- Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suresh V Phatak
- Department of Radiodiagnosis, Narendra Kumar Prasadrao Salve Institute of Medical Sciences and Research Centre, Nagpur, IND
| | - Pratap S Parihar
- Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rajasbala P Dhande
- Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nidhi G Reddy
- Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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15
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Li F, Ma Y, Li X, Zhang D, Han J, Tan D, Mi Y, Yang X, Wang J, Zhu B. Severe persistent mycobacteria antigen stimulation causes lymphopenia through impairing hematopoiesis. Front Cell Infect Microbiol 2023; 13:1079774. [PMID: 36743311 PMCID: PMC9889370 DOI: 10.3389/fcimb.2023.1079774] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/02/2023] [Indexed: 01/20/2023] Open
Abstract
Miliary tubersculosis (TB), an acute systemic blood disseminated tuberculosis mainly caused by Mycobacterium tuberculosis (M. tuberculosis), can cause signs of lymphopenia in clinical patients. To investigate whether/how persistent mycobacteria antigen stimulation impairs hematopoiesis and the therapeutic effect of interleukin-7 (IL-7), a mouse model of Mycobacterium Bovis Bacillus Calmette-Guérin (BCG) intravenous infection with/without an additional stimulation with M. tuberculosis multi-antigen cocktail containing ESAT6-CFP10 (EC) and Mtb10.4-HspX (MH) was established. Consistent with what happened in miliary TB, high dose of BCG intravenous infection with/without additional antigen stimulation caused lymphopenia in peripheral blood. In which, the levels of cytokines IFN-γ and TNF-α in serum increased, and consequently the expression levels of transcription factors Batf2 and IRF8 involved in myeloid differentiation were up-regulated, while the expression levels of transcription factors GATA2 and NOTCH1 involved in lymphoid commitment were down-regulated, and the proliferating activity of bone marrow (BM) lineage- c-Kit+ (LK) cells decreased. Furthermore, recombinant Adeno-Associated Virus 2-mediated IL-7 (rAAV2-IL-7) treatment could significantly promote the elevation of BM lymphoid progenitors. It suggests that persistent mycobacteria antigen stimulation impaired lymphopoiesis of BM hematopoiesis, which could be restored by complement of IL-7.
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Affiliation(s)
- Fei Li
- Gansu Provincial Key Laboratory of Evidence-Based Medicine and Clinical Translation and Lanzhou Center for Tuberculosis Research, Institute of Pathogen Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yanlin Ma
- Gansu Provincial Key Laboratory of Evidence-Based Medicine and Clinical Translation and Lanzhou Center for Tuberculosis Research, Institute of Pathogen Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Xiaoping Li
- Inpatient Ward 1, Lanzhou Pulmonary Hospital, Lanzhou, China
| | - Dan Zhang
- Gansu Provincial Key Laboratory of Evidence-Based Medicine and Clinical Translation and Lanzhou Center for Tuberculosis Research, Institute of Pathogen Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Jiangyuan Han
- Gansu Provincial Key Laboratory of Evidence-Based Medicine and Clinical Translation and Lanzhou Center for Tuberculosis Research, Institute of Pathogen Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Daquan Tan
- Gansu Provincial Key Laboratory of Evidence-Based Medicine and Clinical Translation and Lanzhou Center for Tuberculosis Research, Institute of Pathogen Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Youjun Mi
- Gansu Provincial Key Laboratory of Evidence-Based Medicine and Clinical Translation and Lanzhou Center for Tuberculosis Research, Institute of Pathogen Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China,Institute of Pathophysiology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Xiaojuan Yang
- Gansu Provincial Key Laboratory of Evidence-Based Medicine and Clinical Translation and Lanzhou Center for Tuberculosis Research, Institute of Pathogen Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China,Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Juan Wang
- Gansu Provincial Key Laboratory of Evidence-Based Medicine and Clinical Translation and Lanzhou Center for Tuberculosis Research, Institute of Pathogen Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Bingdong Zhu
- Gansu Provincial Key Laboratory of Evidence-Based Medicine and Clinical Translation and Lanzhou Center for Tuberculosis Research, Institute of Pathogen Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China,State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, Lanzhou, China,*Correspondence: Bingdong Zhu,
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16
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Fukushima S, Ocho K, Fujita K, Hagiya H, Otsuka F. Tuberculous meningitis. Clin Case Rep 2023; 11:e6865. [PMID: 36694639 PMCID: PMC9843065 DOI: 10.1002/ccr3.6865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/16/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
Tuberculous meningitis is possibly complicated with multiple cerebral infarctions and basal meningitis, and the mortality and neurological prognosis is reportedly poor. This case suggested that clinicians should consider tuberculous meningitis as a differential diagnosis of patients with disturbed consciousness in an aging country Japan.
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Affiliation(s)
- Shinnosuke Fukushima
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan,Department of General Medicine and Infectious DiseasesTsuyama Chuo HospitalTsuyamaJapan
| | - Kazuki Ocho
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan,Department of Internal MedicineIshikawa HospitalTsuyamaJapan
| | - Koji Fujita
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan,Department of General Medicine and Infectious DiseasesTsuyama Chuo HospitalTsuyamaJapan
| | - Hideharu Hagiya
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Fumio Otsuka
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
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17
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Muacevic A, Adler JR, Choudhary SS, Khan SM, Wagh P, Upadhyay P. Miliary Tuberculosis with Acute Respiratory Distress Syndrome: A Deadly Combination. Cureus 2023; 15:e33944. [PMID: 36819354 PMCID: PMC9937678 DOI: 10.7759/cureus.33944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/18/2023] [Indexed: 01/20/2023] Open
Abstract
A unique and deadly presentation of miliary tuberculosis is acute respiratory distress syndrome. In this case report, we present the case of a 22-year-old male patient who presented with a history of weight loss, appetite loss for eight months, and rapidly worsening dyspnea for 15 days, for which he was admitted to the intensive care unit. Chest X-ray and computed tomography (CT) of the thorax revealed bilateral miliary opacities. Routine blood tests revealed hyponatremia and leukocytosis. The patient was started on non-invasive ventilatory support, intravenous corticosteroids, and anti-tubercular therapy on clinical and-radiological suspicion of miliary tuberculosis. The patient was admitted for one month and started to show rapid recovery after initiating anti-tubercular and corticosteroid therapy.
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18
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Abstract
BACKGROUND Pregnancy complicated with tuberculosis is increasingly common. The clinical characteristics of pregnancy complicated with miliary tuberculosis are summarized in this study. METHODS A retrospective analysis of pregnant patients with miliary tuberculosis was performed in terms of epidemiology, demography, clinical characteristics, laboratory tests, treatment, and prognosis. RESULTS Of the 23 patients that were included, 12 became pregnant after in vitro fertilization combined with embryo transfer (IVF-ET). The average gestational age at symptom onset was 13.96 weeks, and the average time from symptom onset to diagnosis was 33 days. Clinical symptoms included fever, dyspnoea, cough, headache, abdominal pain, and chest pain. Extrapulmonary tuberculosis occurred in 10 patients, respiratory failure in 11 patients, and ARDS in 9 patients. Chest HRCT showed diffusely distributed miliary nodules in all patients. Six patients were on mechanical ventilation, two underwent ECMO, and one died. Symptoms appeared in the first trimester of nine pregnancies after IVF-ET and in the second trimester of seven natural pregnancies. CONCLUSIONS Miliary tuberculosis can occur in pregnant patients, especially in patients after IVF-ET. Symptoms often appear in the first trimester of pregnancy after IVF-ET and in the second trimester of natural pregnancy. Lacking specificity, the common clinical characteristics include elevated inflammation markers, anaemia, low lymphocyte count, and multiple miliary nodules shown on a chest HRCT scan. Half of patients with miliary tuberculosis may develop respiratory failure, and some may progress to ARDS. Therefore, infertile patients should be required to undergo TB screening before undergoing IVF-ET, and preventive anti-TB treatment should be given to patients with latent TB infections or untreated TB disease.Key MessageMiliary tuberculosis can occur in pregnant patients, especially in pregnant patients after IVF-ET. Symptoms often appear in the first trimester of pregnancy after IVF-ET and in the second trimester of natural pregnancy. Many patients develop respiratory failure or ARDS.
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Affiliation(s)
- Kaige Wang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Donghua Ren
- Department of Pulmonary and Critical Care Medicine, Xining Second People's Hospital, Xining, China
| | - Zhixin Qiu
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Weimin Li
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
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19
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Kurokawa Y, Kawai T, Miyakawa J, Makise N, Akiyama Y, Yamada Y, Sato Y, Yamada D, Ushiku T, Kume H. A case of miliary tuberculosis following transurethral surgery and prostate biopsy after intravesical Bacillus Calmette-Guerin immunotherapy. IJU Case Rep 2022; 5:45-47. [PMID: 35005471 PMCID: PMC8720731 DOI: 10.1002/iju5.12385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/06/2021] [Revised: 08/22/2021] [Accepted: 09/21/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Intravesical Bacillus Calmette-Guerin immunotherapy is known to prevent recurrence of bladder cancer, but it can cause tuberculosis infections as an adverse event. CASE PRESENTATION A 75-year-old man visited our hospital due to hematuria. The patient was diagnosed with bladder cancer and underwent transurethral resection of the bladder tumor. Postoperatively, the patient received Bacillus Calmette-Guerin immunotherapy. One year later, we performed transurethral surgery and prostate biopsy because of cystoscopic findings showing nodulous lesions in the bladder and an elevated serum prostate-specific antigen level. The patient presented with high fever and malaise since the surgery. After careful examination, the patient was diagnosed with miliary tuberculosis caused by Mycobacterium bovis. The pathology of the bladder and prostate revealed acid-fast bacilli collection by Ziehl-Neelsen staining. CONCLUSION The surgery exacerbated the local infection into a systemic infection. The risk of developing miliary tuberculosis should be considered at transurethral surgery or prostate biopsy in patients after intravesical Bacillus Calmette-Guerin immunotherapy.
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Affiliation(s)
- Yoshiaki Kurokawa
- Departments of UrologyGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Taketo Kawai
- Departments of UrologyGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Jimpei Miyakawa
- Departments of UrologyGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Naohiro Makise
- Department of PathologyGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Yoshiyuki Akiyama
- Departments of UrologyGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Yuta Yamada
- Departments of UrologyGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Yusuke Sato
- Departments of UrologyGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Daisuke Yamada
- Departments of UrologyGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Tetsuo Ushiku
- Department of PathologyGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Haruki Kume
- Departments of UrologyGraduate School of MedicineThe University of TokyoTokyoJapan
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20
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Rodriguez-Vargas CM, Vergara N, Arauz AB. Diagnostic Challenge of Acute Hepatitis in Human Immunodeficiency Virus-Positive Patients: With or Without Tuberculosis. Cureus 2021; 13:e16449. [PMID: 34422480 PMCID: PMC8369126 DOI: 10.7759/cureus.16449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Accepted: 07/17/2021] [Indexed: 12/05/2022] Open
Abstract
Tuberculosis (TB) is the leading infectious disease that causes death worldwide, eclipsing HIV/AIDS. It may affect any organ, but the most common manifestation is related to the involvement of the lungs. Hepatic tuberculosis is often a manifestation of disseminated disease and less likely a localized disease. Our case illustrates an HIV-positive patient with disseminated tuberculosis that presented first as liver involvement. After the diagnosis was made through liver biopsy, pulmonary compromise ensued. We review the clinical presentation, diagnosis, and treatment options of disseminated and hepatic TB. Our case is a glimpse of the many faces TB can adopt, especially in HIV-positive patients.
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Affiliation(s)
| | | | - Ana B Arauz
- Infectious Diseases, Hospital Santo Tomás, Panama, PAN
- Internal Medicine, Universidad de Panamá, Panama, PAN
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21
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Askari E, Pourabdollah Toutkaboni M, Haseli S, Rezaei M, Tabarsi P, Marjani M, Moniri A, Khalili N. Not all that is miliary is tuberculosis: Metastatic medullary thyroid carcinoma mimicking miliary tuberculosis. Clin Case Rep 2021; 9:e04231. [PMID: 34026193 PMCID: PMC8123563 DOI: 10.1002/ccr3.4231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/08/2020] [Revised: 01/23/2021] [Accepted: 04/14/2021] [Indexed: 11/06/2022] Open
Abstract
Medullary carcinoma of the thyroid should be considered in the differential diagnosis of miliary pattern of micronodules on chest imaging, irrespective of clinical features.
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Affiliation(s)
- Elham Askari
- Chronic Respiratory Diseases Research CenterNational Research Institute of Tuberculosis and Lung Diseases (NRITLD)Shahid Beheshti University of Medical SciencesTehranIran
| | - Mihan Pourabdollah Toutkaboni
- Chronic Respiratory Diseases Research CenterNational Research Institute of Tuberculosis and Lung Diseases (NRITLD)Shahid Beheshti University of Medical SciencesTehranIran
| | - Sara Haseli
- Chronic Respiratory Diseases Research CenterNational Research Institute of Tuberculosis and Lung Diseases (NRITLD)Shahid Beheshti University of Medical SciencesTehranIran
| | - Mitrasadat Rezaei
- Virology Research CenterNational Research Institute of Tuberculosis and Lung Diseases (NRITLD)Shahid Beheshti University of Medical SciencesTehranIran
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research CenterNational Research Institute of Tuberculosis and Lung Diseases (NRITLD)Shahid Beheshti University of Medical SciencesTehranIran
| | - Majid Marjani
- Clinical Tuberculosis and Epidemiology Research CenterNational Research Institute of Tuberculosis and Lung Diseases (NRITLD)Shahid Beheshti University of Medical SciencesTehranIran
| | - Afshin Moniri
- Virology Research CenterNational Research Institute of Tuberculosis and Lung Diseases (NRITLD)Shahid Beheshti University of Medical SciencesTehranIran
| | - Neda Khalili
- School of MedicineTehran University of Medical SciencesTehranIran
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22
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Noguera-Julian A, Calzada-Hernández J, Brinkmann F, Basu Roy R, Bilogortseva O, Buettcher M, Carvalho I, Chechenyeva V, Falcón L, Goetzinger F, Guerrero-Laleona C, Hoffmann P, Jelusic M, Niehues T, Ozere I, Shackley F, Suciliene E, Welch SB, Schölvinck EH, Ritz N, Tebruegge M. Tuberculosis Disease in Children and Adolescents on Therapy With Antitumor Necrosis Factor-ɑ Agents: A Collaborative, Multicenter Paediatric Tuberculosis Network European Trials Group (ptbnet) Study. Clin Infect Dis 2021; 71:2561-2569. [PMID: 31796965 DOI: 10.1093/cid/ciz1138] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 11/19/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In adults, anti-tumor necrosis factor-α (TNF-α) therapy is associated with progression of latent tuberculosis (TB) infection (LTBI) to TB disease, but pediatric data are limited. METHODS Retrospective multicenter study within the Paediatric Tuberculosis Network European Trials Group, capturing patients <18 years who developed TB disease during anti-TNF-α therapy. RESULTS Sixty-six tertiary healthcare institutions providing care for children with TB participated. Nineteen cases were identified: Crohn's disease (n = 8; 42%) and juvenile idiopathic arthritis (n = 6; 32%) were the commonest underlying conditions. Immune-based TB screening (tuberculin skin test and/or interferon-γ release assay) was performed in 15 patients before commencing anti-TNF-α therapy but only identified 1 LTBI case; 13 patients were already receiving immunosuppressants at the time of screening. The median interval between starting anti-TNF-α therapy and TB diagnosis was 13.1 (IQR, 7.1-20.3) months. All cases presented with severe disease, predominantly miliary TB (n = 14; 78%). One case was diagnosed postmortem. TB was microbiologically confirmed in 15 cases (79%). The median duration of anti-TB treatment was 50 (IQR, 46-66) weeks. Five of 15 (33%) cases who had completed TB treatment had long-term sequelae. CONCLUSIONS LTBI screening is frequently false-negative in this patient population, likely due to immunosuppressants impairing test performance. Therefore, patients with immune-mediated diseases should be screened for LTBI at the point of diagnosis, before commencing immunosuppressive medication. Children on anti-TNF-α therapy are prone to severe TB disease and significant long-term morbidity. Those observations underscore the need for robust LTBI screening programs in this high-risk patient population, even in low-TB-prevalence settings.
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Affiliation(s)
- Antoni Noguera-Julian
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d´Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain.,Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain
| | - Joan Calzada-Hernández
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d´Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
| | - Folke Brinkmann
- Department of Pulmonology, University Children's Hospital, Ruhr University, Bochum, Germany
| | - Robindra Basu Roy
- Department of Paediatrics, Oxford University, Oxford, United Kingdom.,Children's Hospital, John Radcliffe Hospital, Oxford, United Kingdom
| | - Olga Bilogortseva
- Department of Child Phthisiology, National Institute of Phthisiology and Pulmonology, National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | - Michael Buettcher
- Lucerne Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Isabel Carvalho
- Department of Pediatrics, Vila Nova de Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - Vira Chechenyeva
- Department of Child Phthisiology, National Institute of Phthisiology and Pulmonology, National Academy of Medical Sciences of Ukraine, Kiev, Ukraine.,Center of Infectious Diseases, "Clinic for Children With HIV/AIDS", National Specialized Children's Hospital (Okhmatdyt), Kiev, Ukraine
| | - Lola Falcón
- Department of Paediatric Infectious Diseases, Rheumatology and Immunodeficiency, Hospital Virgen del Rocío, Seville, Spain
| | - Florian Goetzinger
- Department of Pediatrics and Adolescent Medicine, Wilhelminenspital, Vienna, Austria
| | - Carmelo Guerrero-Laleona
- Infectious Diseases Unit, Pediatric Department, Miguel Servet University Hospital-University of Zaragoza, Zaragoza, Spain
| | - Peter Hoffmann
- Department of Internal Medicine, Gastroenterology, and Diabetology, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Marija Jelusic
- Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tim Niehues
- Immunodeficiency and Rheumatology Center, Helios Klinikum Krefeld, Krefeld, Germany
| | - Iveta Ozere
- Department of Infectious Diseases and Dermatology, Riga Stradinš University, Riga, Latvia.,Center of Tuberculosis and Lung Diseases, Riga East University Hospital, Riga, Latvia
| | - Fiona Shackley
- Department of Paediatrics, Sheffield Children's National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Elena Suciliene
- Children Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Steven B Welch
- Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Elisabeth H Schölvinck
- University of Groningen, University Medical Center Groningen/Beatrix Children's Hospital, Groningen, the Netherlands
| | - Nicole Ritz
- Paediatric Infectious Diseases and Vaccinology Unit, University of Basel Children's Hospital, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Marc Tebruegge
- Department of Paediatrics, University of Melbourne, Parkville, Australia.,Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Department of Infection, Immunity, and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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23
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Zeng Y, Zhai XL, Wáng YXJ, Gao WW, Hu CM, Lin FS, Chai WS, Wang JY, Shi YL, Zhou XH, Yu HS, Lu XW. Illustration of a number of atypical computed tomography manifestations of active pulmonary tuberculosis. Quant Imaging Med Surg 2021; 11:1651-1667. [PMID: 33816198 DOI: 10.21037/qims-20-1323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Tuberculosis is a serious public health challenge facing mankind and one of the top ten causes of death. Diagnostic imaging plays an important role, particularly for the diagnosis and treatment planning of tuberculosis patients with negative microbiology results. This article illustrates a number of atypical computed tomography (CT) appearances of pulmonary tuberculosis (PTB), including (I) clustered micronodules (CMNs) sign; (II) reversed halo sign (RHS); (III) tuberculous pneumatocele; (IV) hematogenously disseminated PTB with predominantly diffuse ground glass opacity manifestation; (V) hematogenously disseminated PTB with randomly distributed non-miliary nodules; (VI) PTB changes occur on the background of emphysema or honeycomb changes of interstitial pneumonia; and (VII) PTB manifesting as organizing pneumonia. While the overall incidence of PTB is decreasing globally, the incidence of atypical manifestations of tuberculosis is increasing. A good understanding of the atypical CT imaging changes of active PTB shall help the diagnosis and differential diagnosis of PTB in clinical practice.
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Affiliation(s)
- Yi Zeng
- Department of Tuberculosis, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Xiao-Li Zhai
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Wei-Wei Gao
- Department of Tuberculosis, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Chun-Mei Hu
- Department of Tuberculosis, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Fei-Shen Lin
- Department of Tuberculosis, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Wen-Shu Chai
- Department of Respiratory Medicine, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Jian-Yun Wang
- Department of Radiology, Lanzhou Lung Hospital, Lanzhou, China
| | - Yan-Ling Shi
- Department of Radiology, Second Hospital of Daqing City, Daqing, China
| | - Xin-Hua Zhou
- Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Hui-Shan Yu
- Department of Radiology, Wuhan Pulmonary Hospital, Wuhan, China
| | - Xi-Wei Lu
- Department of Tuberculosis, Dalian Tuberculosis Hospital, Dalian, China
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24
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Nasu S, Kawahara K, Han Y, Okamoto N, Tamura Y, Suzuki H, Shiroyama T, Samejima Y, Kanai T, Noda Y, Tanaka A, Morishita N, Ueda K, Hashimoto S, Hirashima T, Nagai T. Transbronchial Cryobiopsy for Miliary Tuberculosis Mimicking Hypersensitivity Pneumonitis. Intern Med 2021; 60:445-448. [PMID: 32963150 PMCID: PMC7925263 DOI: 10.2169/internalmedicine.4511-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/22/2022] Open
Abstract
Miliary tuberculosis is a potentially lethal type of tuberculosis that results from the hematogenous dissemination of Mycobacterium tuberculosis bacilli. We herein describe the case of a 34-year-old man that presented with a one-month history of cough and fever, while his sputum smear results were negative. Chest computed tomography revealed bilateral centrilobular ground-glass opacification (GGO), suggestive of hypersensitivity pneumonitis; thus, bronchoscopy was performed. Cryobiopsy specimens revealed necrotic granulomas. A re-examination of sputum after bronchoscopy identified Mycobacterium tuberculosis, and miliary tuberculosis was diagnosed. A cryobiopsy might be useful for diagnosing miliary tuberculosis pathologically, particularly when miliary nodules may be masked by GGO.
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Affiliation(s)
- Shingo Nasu
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Kunimitsu Kawahara
- Department of Pathology Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, Japan
| | - Yuki Han
- Department of Infectious Diseases, Osaka Habikino Medical Center, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Yoshitaka Tamura
- Department of Infectious Diseases, Osaka Habikino Medical Center, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | | | - Yumiko Samejima
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Tomohiro Kanai
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Yoshimi Noda
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Kayo Ueda
- Department of Pathology Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, Japan
| | - Shoji Hashimoto
- Department of Infectious Diseases, Osaka Habikino Medical Center, Japan
| | | | - Takayuki Nagai
- Department of Infectious Diseases, Osaka Habikino Medical Center, Japan
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25
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Kilinc S, Bostan O, Erol M, Erturk S, Dilek D, Yigit O. Successful management with bisphosphonate treatment in a child with tuberculosis-associated hypercalcemia. North Clin Istanb 2020; 7:411-4. [PMID: 33043270 DOI: 10.14744/nci.2019.14890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 05/21/2019] [Indexed: 11/20/2022] Open
Abstract
Hypercalcemia is a common metabolic abnormality in children and generally occurs due to hyperparathyroidism, vitamin D toxicity, some genetic disorders and malignant diseases. Granulomatous diseases are a rare cause of hypercalcemia in children, which are usually mild and asymptomatic. Severe hypercalcemia in granulomatous diseases has also been reported in the literature. Here, we report a child presenting with severe hypercalcemia secondary to miliary tuberculosis with successful management with bisphosphonate treatment. Increased 1,25(OH)2D3 synthesis by activated macrophages in the granuloma tissue is the major mechanism of hypercalcemia in tuberculosis.
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26
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Zia Z, Iqbal QZ, Narula N, Sattar SBA, Rafay Khan Niazi M. Miliary Tuberculosis in a Young Patient? Let's Not Forget the Lung Adenocarcinoma! Cureus 2020; 12:e10058. [PMID: 32999781 PMCID: PMC7520401 DOI: 10.7759/cureus.10058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 12/04/2022] Open
Abstract
Lung cancer is one of the most common cancers diagnosed every year and accounts for a major percentage of cancer incidence and mortality annually, especially in men. Lung adenocarcinoma is a subtype of non-small cell lung cancer (NSCLC), which is the most common type of lung cancer found in smokers and nonsmokers alike. It is known to have diverse CT chest findings ranging from: ground-glass opacities (GGOs) with partially solid nodules, to single or multiple solid nodules that can be either central or peripheral, to thin-walled cystic lesions. Lesions are usually solitary but may be multifocal. Rarely, these lesions can be calcified or demonstrate cavitation, which can make it difficult to distinguish from an infectious disease like tuberculosis, pneumonia, or even fungal infections. Here, we present a case of a 36-year-old Asian male with no significant past medical history, except a 16-pack-year smoking history and recent deployment to Afghanistan, that initially presented with a chief complaint of cough of three-week duration. His CT scan showed innumerable bilateral pulmonary nodules within both lung fields with a miliary type appearance that ultimately turned out to be adenocarcinoma.
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Affiliation(s)
- Zeeshan Zia
- Internal Medicine, Northwell Health-Staten Island University Hospital, New York, USA
| | - Qasim Z Iqbal
- Internal Medicine, Northwell Health-Staten Island University Hospital, New York, USA
| | - Naureen Narula
- Internal Medicine, Northwell Health-Staten Island University Hospital, New York, USA
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27
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Sun JM, Wang C, Jin DQ, Deng F. Fatal congenital tuberculosis owing to late diagnosis of maternal tuberculosis: case report and review of congenital tuberculosis in China. Paediatr Int Child Health 2020; 40:194-198. [PMID: 32195623 DOI: 10.1080/20469047.2020.1743932] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Congenital tuberculosis (TB) is rare and the prognosis is poor if not detected early. The diagnosis is often delayed owing to non-specific clinical presentation, misdiagnosis and undiagnosed maternal TB during pregnancy. A 12-day-old girl presented with a 5-day history of fever, cough, poor feeding and respiratory distress. Her mother had a cough and fever at 30 weeks gestation which was managed empirically as community-acquired pneumonia without a TB workup. Immediately postpartum, her mother developed a high fever and shortness of breath and required admission to the intensive care unit. The infant was separated from her mother after delivery. The infant's chest radiograph showed bilateral miliary nodules. Thoracic and abdominal computed tomography (CT) showed multiple enlarged lymph nodes and congenital TB was suspected. Early morning gastric aspirate and sputum (obtained through a suction tube) were positive for acid-fast bacilli on smear microscopy and subsequently Mycobacterium tuberculosis was cultured from both specimens. Lumbar puncture was performed and cerebrospinal fluid (CSF) was compatible with TB meningitis. TB-polymerase chain reaction (TB-PCR) was positive. Her mother was diagnosed with miliary TB on postpartum day 17. Both were given anti-TB chemotherapy. Unfortunately, despite the treatment, the infant died from multiple organ dysfunction syndrome (MODS) caused by congenital TB at the age of 14 days. This case highlights the importance of screening pregnant women for TB in regions where it is highly prevalent. A high index of suspicion of maternal and congenital TB is critical to early diagnosis, especially in such regions.
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Affiliation(s)
- Jing-Min Sun
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University , Anhui, China
| | - Chang Wang
- Department of Radiology, Anhui Province Children's Hospital , Anhui, China
| | - Dan-Qun Jin
- Department of Pediatrics, Anhui Province Children's Hospital , Anhui, China
| | - Fang Deng
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University , Anhui, China
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28
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Rajagopala S, Sankari S, Kancherla R, Ramanathan RP, Balalakshmoji D. Miliary Sarcoidosis: does it exist? A case series and systematic review of literature. Sarcoidosis Vasc Diffuse Lung Dis 2020; 37:53-65. [PMID: 33093769 PMCID: PMC7569537 DOI: 10.36141/svdld.v37i1.7837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/24/2020] [Indexed: 12/18/2022]
Abstract
Background and Objectives: Sarcoidosis typically presents with peribronchovascular and perilymphatic nodules on high-resolution computed tomography (HRCT); a miliary pattern is reported but not well described. Design, setting: We describe four patients with miliary sarcoidosis and results of a systematic review of all previously reported cases from 1985 onwards. Results: We identified only 27 cases of “miliary” sarcoidosis in the HRCT era. These patients were older (85.2% older than 40 years), had more co-morbidities (72.7%) and were symptomatic compared to “typical” sarcoidosis. Respiratory symptoms were present in 61.9% at diagnosis. Hypercalcemia was seen in 28.5%. On review of HRCT images, only 34.6% (9/26) had a “true miliary” pattern without fissural nodules. In our series, prominent perivascular granulomas were seen on histopathology in all. 44.4% (12/27) had tuberculosis preceding or concurrent to miliary sarcoidosis. Of the eight true associations, tuberculosis preceded sarcoidosis by 52 (median, IQR 36) weeks in six and occurred concurrently in another two. The diagnosis of tuberculosis was clinical in all with concurrent diagnosis of tuberculosis and sarcoidosis. Treatment with steroids had 100% response and 14.2% relapse. Conclusions: A true miliary pattern in the HRCT era is very rare in sarcoidosis and subtle perilymphatic pattern is nearly always seen; this should be labeled “pseudo-miliary”. Prominent perivascular granulomas are associated with true miliary pattern. Miliary sarcoidosis patients are older and symptomatic, needing treatment at diagnosis. “Miliary” sarcoidosis may follow treatment for tuberculosis; concurrent cases possibly indicate the difficulty in differentiating both or a “tuberculo-sarcoid” presentation. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (1): 53-65)
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Affiliation(s)
| | | | | | | | - Devanand Balalakshmoji
- Radiodiagnosis, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, India
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29
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Okuno H, Hagiya H, Hamaguchi S, Tomono K. Repeated Chest Computed Tomography Revealed Early-stage Miliary Tuberculosis. Intern Med 2020; 59:461-462. [PMID: 31588079 PMCID: PMC7028422 DOI: 10.2169/internalmedicine.3121-19] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hideo Okuno
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Hideharu Hagiya
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Shigeto Hamaguchi
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Kazunori Tomono
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
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30
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Piastra M, Picconi E, Morena TC, Valentini P, Buonsenso D, Conti G, Antonelli M, Wolfler AM, Chidini G, Pons-Òdena M, De Pascale G. Miliary tuberculosis leading to acute respiratory distress syndrome: Clinical experience in pediatric intensive care. Pediatr Pulmonol 2019; 54:2003-2010. [PMID: 31496114 DOI: 10.1002/ppul.24510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 08/24/2019] [Indexed: 11/08/2022]
Abstract
Acute respiratory distress syndrome (ARDS) represents a rare complication of miliary tuberculosis (TB) in the adult setting, and it is even less common in the pediatric population. The presence of comorbidities and the possibility of a delayed diagnosis may further impair the clinical prognosis of critically ill patients with disseminated TB and acute respiratory failure. In this report, we present a case series of five pediatric patients with miliary TB and ARDS, where rescue and multimodal respiratory support strategies have been applied with a favorable outcome in more than half of them. The burden of miliary TB over time on a general pediatric intensive care unit-including two ARDS patients-is also illustrated.
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Affiliation(s)
- Marco Piastra
- Pediatric ICU and Trauma Center, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Anesthesiology and Intensive Care, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Enzo Picconi
- Pediatric ICU and Trauma Center, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tony C Morena
- Pediatric ICU and Trauma Center, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Piero Valentini
- Department of Pediatrics, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Danilo Buonsenso
- Department of Pediatrics, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Conti
- Pediatric ICU and Trauma Center, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Anesthesiology and Intensive Care, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea M Wolfler
- Intensive Care Unit, "V. Buzzi" Pediatric Hospital, ICP, Milan, Italy
| | - Giovanna Chidini
- Pediatric Intensive Care Unit, "De Marchi" Policlinico Universitario, Milan, Italy
| | - Martí Pons-Òdena
- Intensive Care Unit, Sant Joan de Déu Pediatric Hospital, Barcelona, Spain
| | - Gennaro De Pascale
- Department of Anesthesiology and Intensive Care, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
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31
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Abstract
Miliary mottling on imaging is usually infectious in etiology and is less commonly seen with metastatic cancers. The cancers that are reported to cause miliary metastases include secondaries from cancers of the thyroid, kidney, trophoblasts, etc. Here, we report a case of a 63-year-old female who presented with prolonged cough and shortness of breath and whose imaging showed diffuse bilateral miliary nodules. Bronchoscopy with a transbronchial biopsy confirmed the diagnosis as adenocarcinoma of the lung with intrapulmonary miliary metastasis. Treatment with a combination of pemetrexed and carboplatin was not helpful and cancer had spread diffusely across the lung on repeat imaging after three months. It is essential to consider this clinical presentation as a separate subtype, with specific treatment protocols as compared to primary adenocarcinoma of the lung.
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Affiliation(s)
- Saran Pillai
- Emergency Medicine, Kerala Institute of Medical Sciences Hospital, Trivandrum, IND
| | - Adnan Khan
- Critical Care, Freeman Health System, Joplin, USA
| | - Sana Khan
- Internal Medicine, Sindh Medical College, Karachi, PAK
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32
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Diaz A, Osorio N, Watson JR. Painless Skin Ulcer in a 5-Year-Old Girl From Colombia. J Pediatric Infect Dis Soc 2019; 8:180-183. [PMID: 30184211 DOI: 10.1093/jpids/piy089] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/28/2018] [Indexed: 11/14/2022]
Affiliation(s)
- Alejandro Diaz
- Division of Pediatric Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio
| | - Natalia Osorio
- Hospital Pediatrics, Hospital General de Medellin, Universidad CES, Colombia
| | - Joshua R Watson
- Division of Pediatric Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio
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33
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Garg RK, Rizvi I, Malhotra HS, Uniyal R, Kumar N. Management of complex tuberculosis cases: a focus on drug-resistant tuberculous meningitis. Expert Rev Anti Infect Ther 2019; 16:813-831. [PMID: 30359140 DOI: 10.1080/14787210.2018.1540930] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Drug-resistant tuberculous meningitis has been reported worldwide. Isoniazid mono-resistance is the most frequent cause of drug-resistant tuberculous meningitis, a life-threatening disease. Extensive drug-resistant tuberculous meningitis has also been reported in some isolated case reports. Areas covered: We reviewed the current literature on drug-resistant tuberculous meningitis, as well as drug-resistant tuberculosis. Expert commentary: Drug-resistant tuberculous meningitis is a life-threatening disease and needs prompt diagnosis and treatment. Xpert MTB/RIF Ultra technology can detect Mycobacterium tuberculosis and rifampicin resistance in cerebrospinal fluid (CSF) even with low numbers of bacilli. The optimum antituberculosis drug regimen for multidrug-resistant tuberculous meningitis is largely unknown as no second-line antituberculosis drug-containing regimen has been tested in a randomized controlled fashion in drug-resistant tuberculous meningitis. A combination of levofloxacin, kanamycin, ethionamide, linezolid, and pyrazinamide would be an appropriate regimen because of excellent CSF profile of most of these drugs. End TB Strategy will help in checking the increasing challenge of drug-resistant tuberculous meningitis as it aims to eliminate all kinds of tuberculosis by the year 2035.
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Affiliation(s)
- Ravindra Kumar Garg
- a Department of Neurology , King George Medical University , Lucknow , India
| | - Imran Rizvi
- a Department of Neurology , King George Medical University , Lucknow , India
| | | | - Ravi Uniyal
- a Department of Neurology , King George Medical University , Lucknow , India
| | - Neeraj Kumar
- a Department of Neurology , King George Medical University , Lucknow , India
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34
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Neugebauer F, Tuma J, Serra AL, Stieger R, Rohacek M. [Point-of-Care Ultrasound: Teaching and Learning in Ifakara, Tanzania]. Praxis (Bern 1994) 2018; 107:1279-1282. [PMID: 30424685 DOI: 10.1024/1661-8157/a003118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Point-of-Care Ultrasound: Teaching and Learning in Ifakara, Tanzania Abstract. Presentation of two practical cases from the point-of-care ultrasound class in Ifakara, Tanzania. The first case shows the sonographic findings of tuberculosis with findings in the lungs, heart, abdominal lymph nodes and spleen. In the second case, detection of an enterobiliary fistula by sonographic live imaging of air passing from the intestine into the gall bladder and causing non-iatrogenic pneumobilia.
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Affiliation(s)
| | - Jan Tuma
- 1 Ultrasound Learning Center, Klinik Hirslanden Zürich
| | | | - Roland Stieger
- 2 pataSono - Mobile Ultrasound and Hands-on-Training, Kilifi and Mombasa, Kenia
| | - Martin Rohacek
- 3 Emergency Dpt, St Francis Referral Hospital and Ifakara Health Institute, Ifakara, Tanzania
- 4 Swiss Tropical and Public Health Institute, Basel
- 5 Universität Basel
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35
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Herreros B, Plaza I, García R, Chichón M, Guerrero C, Pintor E. Miliary Tuberculosis Presenting with Hyponatremia and ARDS in an 82-Year-Old Immunocompetent Female. Pathogens 2018; 7:E72. [PMID: 30189694 PMCID: PMC6161313 DOI: 10.3390/pathogens7030072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/05/2018] [Revised: 08/28/2018] [Accepted: 08/28/2018] [Indexed: 01/09/2023] Open
Abstract
An immunocompetent 82-year-old female was admitted to our hospital due to fever without clear origin and hyponatremia. In the following days, an acute and bilateral pulmonary infiltrate appeared with a progressive worsening in respiratory function. Chest x-ray and CT (Computed tomography) showed bilateral reticulonodular infiltrates. Bronchoscopic aspiration and bronchoalveolar lavage (BAL), and transbronchial lung biopsy (TBBX) studies did not reveal microbiological and histopathological diagnosis. Broad-spectrum antibiotics were non-effective, and the patient died due to respiratory failure. Necropsy study revealed a miliary tuberculosis affecting lungs, liver, bone marrow, spleen, kidney, arteries, pancreas, and adrenal glands. Some weeks after the patient´s death, mycobacterial cultures from sputum, BAL and TBBX samples were positive for Mycobacterium tuberculosis.
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Affiliation(s)
- Benjamín Herreros
- Department of Internal Medicine, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain.
- School of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain.
| | - Isabel Plaza
- Department of Nuclear Medicine, Hospital Puerta de Hierro, 28222 Madrid, Spain.
| | - Rebeca García
- Department of Internal Medicine, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain.
| | - Marta Chichón
- Department of Internal Medicine, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain.
| | - Carmen Guerrero
- Department of Pathology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain.
| | - Emilio Pintor
- School of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain.
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Abstract
Congenital tuberculosis is rare, even where tuberculosis (TB) is endemic. A 14-day-old girl presented with a 3-day history of fever and respiratory distress. Her mother was diagnosed with a disseminated TB infection immediately after the delivery which was confirmed by a positive TB-polymerase chain reaction (TB-PCR) and subsequent culture from ascites and sputum. The infant was separated from her mother at birth. Her chest radiograph showed bilateral miliary nodules. Congenital TB was strongly suspected because of the symptoms, signs and maternal TB history, and was confirmed by TB-PCR and culture from the gastric lavage. Timely administration of standard anti-TB therapy resulted in a good outcome. The case highlights the importance of maternal TB history and typical miliary pattern on chest radiography for early diagnosis of congenital or neonatal TB which in turn facilitates prompt treatment and the prognosis.
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Affiliation(s)
- Ching-Wen Chang
- a Department of Medical Imaging and Intervention , Chang Gung Memorial Hospital, Linkou, Chang Gung University , Taoyuan , Taiwan
| | - Patricia Wanping Wu
- a Department of Medical Imaging and Intervention , Chang Gung Memorial Hospital, Linkou, Chang Gung University , Taoyuan , Taiwan
| | - Chih-Hua Yeh
- a Department of Medical Imaging and Intervention , Chang Gung Memorial Hospital, Linkou, Chang Gung University , Taoyuan , Taiwan
| | - Kin-Sun Wong
- b Division of Pediatric Pulmonology, Department of Pediatrics , Chang Gung Children's Hospital , Taoyuan , Taiwan
| | - Chao-Jan Wang
- a Department of Medical Imaging and Intervention , Chang Gung Memorial Hospital, Linkou, Chang Gung University , Taoyuan , Taiwan
| | - Chih-Chen Chang
- a Department of Medical Imaging and Intervention , Chang Gung Memorial Hospital, Linkou, Chang Gung University , Taoyuan , Taiwan
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37
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Macauley P, Rapp M, Park S, Lamikanra O, Sharma P, Marcelin M, Sharma K. Miliary Tuberculosis Presenting With Meningitis in a Patient Treated With Mycophenolate for Lupus Nephritis: Challenges in Diagnosis and Review of the Literature. J Investig Med High Impact Case Rep 2018; 6:2324709618770226. [PMID: 29707591 PMCID: PMC5912272 DOI: 10.1177/2324709618770226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/09/2017] [Revised: 03/06/2018] [Accepted: 03/18/2018] [Indexed: 12/31/2022] Open
Abstract
Tuberculosis is one of the top 10 causes of death worldwide according to the World Health Organization. Central nervous system involvement is usually the least common presentation of tuberculosis occurring in about 1% of all cases but yet can have very devastating outcomes. Lupus nephritis is one of the most common complications of systemic lupus erythematosus with up to two thirds of patients presenting with some degree of renal dysfunction. The mainstay of treatment is glucocorticoids; however, to sustain remission, steroid sparing agents such as cyclophosphamide, azathioprine and mycophenolate mofetil are used. Such patients, in addition to their baseline dysfunctional immune system, have a heightened risk of infections due to these drugs. In this article, we present a young woman who had recently been started on mycophenolate mofetil for control of class V lupus nephritis who presented with headaches, sinus pressure, and fevers. She had a protracted course of hospitalization as she failed to improve clinically and to respond to conventional therapy for acute bacterial sinusitis and meningitis. She was empirically started on antitubercular therapy 9 days after hospitalization. The diagnosis was not confirmed until day 18, the day results of cerebrospinal fluid acid-fast bacillus culture was reported. This case is reported to highlight the challenges in diagnosing Mycobacterium tuberculosis infection in an immunocompromised state and to demonstrate that its presentation can mimic numerous other conditions. Clinicians must maintain a high index of suspicion of Mycobacterium tuberculosis infection in such patients who present with nonspecific or unexplainable symptoms.
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Affiliation(s)
| | - Mark Rapp
- Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sarah Park
- Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA
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38
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Vélez-Tirado N, Cote-Orozco JE. An Infectious Masquerader. Pediatr Neurol 2018; 81:51. [PMID: 29398165 DOI: 10.1016/j.pediatrneurol.2017.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 11/06/2017] [Accepted: 12/05/2017] [Indexed: 11/20/2022]
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Kim CH, Kim EJ, Cha SI, Lee J. The Diagnostic Yield of Urine Cultures with Liquid Media in Cases of Miliary Tuberculosis. Intern Med 2018; 57:913-914. [PMID: 29225259 PMCID: PMC5891541 DOI: 10.2169/internalmedicine.9488-17] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Chang Ho Kim
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Republic of Korea
| | - Eun Jin Kim
- Department of Internal Medicine, Daegu Catholic University Medical Center, Republic of Korea
| | - Seung Ick Cha
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Republic of Korea
| | - Jaehee Lee
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Republic of Korea
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40
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Abstract
BACKGROUND Ocular morbidity associated with systemic tuberculosis is common. The clinical picture varies from anterior uveitis, intermediate uveitis and posterior uveitis to even panuveitis. There is little data on the correlation between specific systemic presentations and the ocular inflammation. We conducted a retrospective review of the ocular findings in the case records of patients admitted with a diagnosis of miliary tuberculosis. These patients were then referred for a more detailed ophthalmic evaluation. METHODS We analysed the case records of patients with a clinical diagnosis of miliary tuberculosis over a 10-year period at Lilavati Hospital and Research Center, Mumbai. RESULTS In total, 11 immunocompetent patients were identified. All 22 eyes showed normal findings on slit lamp examination. Dilated fundus examination showed single or multiple tubercles. In our cohort, the ocular findings were exclusively in the form of choroidal tuberculosis, either unilaterally or bilaterally. Slit lamp examination revealed no anterior segment inflammation Conclusions: We suggest that this pattern of choroidal/retinal tuberculosis in the absence of anterior and intermediate segment inflammation is specific for miliary tuberculosis and may be related to a specific immune response.
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Affiliation(s)
- Salil Mehta
- Department of Ophthalmology, Lilavati Hospital and Research Center, Bandra Reclamation, Mumbai, 400050, India
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41
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Abstract
We describe an unusual case of miliary tuberculous epididymo-orchitis following a BCG-therapy, mimicking malignancy at initial presentation. Genitourinary tuberculosis in a miliary pattern is rare and this case report emphasizes the importance of meticulous analysis of the patient’s clinical history combined with imaging findings in order to ensure an adequate diagnosis and treatment.
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Singh A, Mohan A, Dey AB, Mitra DK. Programmed death-1 + T cells inhibit effector T cells at the pathological site of miliary tuberculosis. Clin Exp Immunol 2017; 187:269-283. [PMID: 27665733 PMCID: PMC5217927 DOI: 10.1111/cei.12871] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 05/05/2016] [Revised: 09/17/2016] [Accepted: 09/21/2016] [Indexed: 01/07/2023] Open
Abstract
Optimal T cell activation is vital for the successful resolution of microbial infections. Programmed death-1 (PD-1) is a key immune check-point receptor expressed by activated T cells. Aberrant/excessive inhibition mediated by PD-1 may impair host immunity to Mycobacterium tuberculosis infection, leading to disseminated disease such as miliary tuberculosis (MTB). PD-1 mediated inhibition of T cells in pulmonary tuberculosis and TB pleurisy is reported. However, their role in MTB, particularly at the pathological site, remains to be addressed. The objective of this study was to investigate the role of PD-1-PD-ligand 1 (PD-L1) in T cell responses at the pathological site from patients of TB pleurisy and MTB as clinical models of contained and disseminated forms of tuberculosis, respectively. We examined the expression and function of PD-1 and its ligands (PD-L1-PD-L2) on host immune cells among tuberculosis patients. Bronchoalveolar lavage-derived CD3 T cells in MTB expressed PD-1 (54·2 ± 27·4%, P ≥ 0·0009) with significantly higher PD-1 ligand-positive T cells (PD-L1: 19·8 ± 11·8%; P ≥ 0·019, PD-L2: 12·6 ± 6·2%; P ≥ 0·023), CD19+ B cells (PD-L1: 14·4 ± 10·4%; P ≥ 0·042, PD-L2: 2·6 ± 1·43%; not significant) and CD14+ monocytes (PD-L1: 40·2 ± 20·1%; P ≥ 0·047, PD-L2: 22·4 ± 15·6%; P ≥ 0·032) compared with peripheral blood (PB) of MTB and healthy controls. The expression of PD-1 was associated with a diminished number of cells producing effector cytokines interferon (IFN)-γ, tumour necrosis factor (TNF)-α, interleukin (IL)-2 and elevated apoptosis. Locally accumulated T cells were predominantly PD-1+ -PD-L1+ , and blocking this pathway restores the protective T cell response. We conclude that M. tuberculosis exploits the PD-1 pathway to evade the host immune response by altering the T helper type 1 (Th1) and Th2 balance at the pathological site of MTB, thereby favouring disease dissemination.
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Affiliation(s)
- A. Singh
- Department of Transplant Immunology and ImmunogeneticsAll India Institute of Medical SciencesNew DelhiIndia
| | - A. Mohan
- Department of MedicineAll India Institute of Medical SciencesNew DelhiIndia
| | - A. B. Dey
- Department of MedicineAll India Institute of Medical SciencesNew DelhiIndia
| | - D. K. Mitra
- Department of Transplant Immunology and ImmunogeneticsAll India Institute of Medical SciencesNew DelhiIndia
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43
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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.
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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
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Asaji M, Tobino K, Murakami K, Goto Y, Sueyasu T, Nishizawa S, Yoshimine K, Munechika M, Ko Y, Yoshimatsu Y, Tsuruno K, Ide H, Miyajima H, Ebi N. Miliary Tuberculosis in a Young Woman with Hemophagocytic Syndrome: A Case Report and Literature Review. Intern Med 2017. [PMID: 28626190 PMCID: PMC5505920 DOI: 10.2169/internalmedicine.56.8025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 01/06/2023] Open
Abstract
We herein report a rare case of miliary tuberculosis-associated hemophagocytic syndrome (HPS) complicated with respiratory failure. A 19-year-old Japanese woman with a fever, general malaise, and chest radiograph abnormalities was referred to our hospital. After admission, she developed respiratory failure with pancytopenia. A histological examination of lung and bone marrow biopsy samples revealed noncaseating granulomas without evidence of acid-fast bacilli or lymphoma. In addition, a bone marrow biopsy showed marked histiocyte hyperplasia with hemophagocytosis, and a bronchoalveolar lavage fluid culture grew Mycobacterium tuberculosis. Therefore, a diagnosis of miliary tuberculosis-associated HPS was made. The patient was successfully treated with antituberculous therapy.
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Affiliation(s)
- Mina Asaji
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Japan
- Department of Respiratory Medicine, Juntendo University, School of Medicine, Japan
| | | | - Yuki Goto
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | - Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | | | | | | | - Yuki Ko
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | | | - Kosuke Tsuruno
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | - Hiromi Ide
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | | | - Noriyuki Ebi
- Department of Respiratory Medicine, Iizuka Hospital, Japan
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45
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Abstract
As a treatment for superficial transitional cell carcinoma, Bacillus Calmette-Guerin (BCG) intravesical instillation can rarely cause unpredictable systemic side effects. We describe a patient admitted due to continuous pyrexia and general fatigue. He was previously treated with intravesical BCG. Laboratory data indicated a hepatic disorder, and chest computed tomography revealed extensive bilateral miliary nodules. Transbronchial lung biopsy specimens showed several small noncaseating granulomas. The diagnosis was unsolved on the basis of acid fast staining, polymerase chain reaction and microbiological cultures, so we considered the possibility of BCG side effect-induced granuloma. Two months after treatment with antituberculous agents and corticosteroids, his clinical symptoms were improved.
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Affiliation(s)
- Kyohei Kaburaki
- Department of Respiratory Medicine, Toho University School of Medicine, Japan
| | - Keishi Sugino
- Department of Respiratory Medicine, Toho University School of Medicine, Japan
| | - Muneyuki Sekiya
- Department of Respiratory Medicine, Toho University School of Medicine, Japan
| | - Yujiro Takai
- Department of Respiratory Medicine, Toho University School of Medicine, Japan
| | - Kazutoshi Shibuya
- Department of Surgical Pathology, Toho University School of Medicine, Japan
| | - Sakae Homma
- Department of Respiratory Medicine, Toho University School of Medicine, Japan
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46
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Tatari A, Ramanujam S, Mathai S, Karabulut N, Moser RL, Wallach SL. Miliary tuberculosis and acquired immunodeficiency syndrome - 'a cursed duet'. J Community Hosp Intern Med Perspect 2016; 6:32131. [PMID: 27802849 PMCID: PMC5089153 DOI: 10.3402/jchimp.v6.32131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/03/2016] [Revised: 08/08/2016] [Accepted: 08/11/2016] [Indexed: 11/14/2022] Open
Abstract
Tuberculous osteomyelitis is rare and usually involves the vertebrae but is seldom found in the foot. The uncommon site and ability to mimic other disorders clinically and radiographically leads to diagnostic and therapeutic delays. We report a case of a 40-year-old man who initially presented to his podiatrist with intermittent pain and swelling of his right ankle and foot that lasted for a year. He also started to exhibit significant weight loss and unexplained fevers and was subsequently hospitalized for cellulitis of his right foot. On further workup, patient was found to have miliary tuberculosis (TB) and acquired immunodeficiency syndrome (AIDS). Patient was treated with anti-TB therapy for 9 months and highly active anti-retroviral therapy. Our patient presented with ongoing chronic right foot and ankle pain that was proven to be secondary to TB osteomyelitis of cuneiform bones of the right ankle in the setting of AIDS. The patient's clinical presentation was unusual due to symptom duration and lack of systemic characteristics. Like our case, reported incidence of osteomyelitis of bone/joint in extrapulmonary TB is estimated to be 10%, and out of all bones/joint TB cases, only 1% are found to be in the foot.
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Affiliation(s)
- Atif Tatari
- Department of Internal Medicine, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA.,Department of Medicine, St Francis Medical Center, Trenton, NJ, USA;
| | - Sahana Ramanujam
- Department of Internal Medicine, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA.,Department of Medicine, St Francis Medical Center, Trenton, NJ, USA
| | - Suja Mathai
- Section of Infectious Disease, Department of Internal Medicine, St. Francis Medical Center, Trenton, NJ, USA
| | - Nigahus Karabulut
- Section of Infectious Disease, Department of Internal Medicine, St. Francis Medical Center, Trenton, NJ, USA
| | - Robert L Moser
- Department of Pathology, St Francis Medical Center, Trenton, NJ, USA
| | - Sara L Wallach
- Department of Internal Medicine, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA.,Department of Medicine, St Francis Medical Center, Trenton, NJ, USA
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47
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Saitou M, Suzuki T, Niitsuma K. Intestinal perforation due to paradoxical reaction during treatment for miliary tuberculosis. Respirol Case Rep 2016; 4:e00196. [PMID: 28031831 PMCID: PMC5167327 DOI: 10.1002/rcr2.196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 08/06/2016] [Revised: 09/17/2016] [Accepted: 09/20/2016] [Indexed: 11/23/2022] Open
Abstract
A 61‐year‐old man was being treated for poor nutritional status. He had been on weekly methotrexate 6 mg and daily tacrolimus 1 mg and prednisolone 18 mg for 8 years due to dermatomyositis. On further workup, he was initially detected to have ileocecal ulcer with subsequent development of diffuse miliary shadows on chest radiograph. He was diagnosed as having ileocecal with miliary tuberculosis (TB). While receiving anti‐tuberculous therapy, there was initial improvement of TB‐related symptoms and he had no conditions that interfered with the efficiency of the anti‐tuberculous therapy. However, he developed intestinal perforation. Emergency surgery for resection of the ileocecal ulcer and ileocolostomy led to improvement and he was finally discharged. Recently, cases of intestinal TB have been rare and perforation due to TB is extraordinary. In this case, paradoxical reaction and poor nutritional status may have contributed to the intestinal perforation.
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Affiliation(s)
- Miwako Saitou
- Department of Infectious Disease and Pulmonary Medicine, Aizu Medical Center Fukushima Medical University Aizuwakamatsu Japan
| | - Tomoko Suzuki
- Department of Infectious Disease and Pulmonary Medicine, Aizu Medical Center Fukushima Medical University Aizuwakamatsu Japan
| | - Katsunao Niitsuma
- Department of Infectious Disease and Pulmonary Medicine, Aizu Medical Center Fukushima Medical University Aizuwakamatsu Japan
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48
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Arora T, Sharma N, Shashni A, Titiyal JS. Peripheral ulcerative keratitis associated with chronic malabsorption syndrome and miliary tuberculosis in a child. Oman J Ophthalmol 2016; 8:205-7. [PMID: 26903734 PMCID: PMC4738673 DOI: 10.4103/0974-620x.169888] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 16-year-old girl presented with pain, redness, watering, and blurring of vision in her right eye. Slit lamp examination revealed the presence of peripheral ulcerative keratitis (PUK) and nodular scleritis. On clinical examination, the patient had stunted growth, low body mass index, and enlarged axillary nodes. Giardia cysts were present in the stool sample and histopathology of axillary lymph nodes showed caseating necrosis suggestive of tuberculosis (TB). A diagnosis of PUK with chronic malabsorption syndrome secondary to giardiasis and miliary TB was made. Oral metronidazole, anti-tubercular treatment, high protein diet and vitamin supplements were started. Topical steroids were started for peripheral ulcerative lesions following, which the PUK resolved.
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Affiliation(s)
- Tarun Arora
- Cornea and Refractive Surgery Services, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Shashni
- Cornea and Refractive Surgery Services, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Cornea and Refractive Surgery Services, All India Institute of Medical Sciences, New Delhi, India
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49
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Abstract
Presence of miliary shadows in chest imaging in the appropriate clinical setting is often taken as a marker of miliary tuberculosis. If sputum is negative for acid -fast bacillus, empirical anti-tubercular therapy is given without securing a histological or microbiological diagnosis. We report a young female with human immunodeficiency virus infection who had miliary infiltrates on chest radiography. She was started on empirical anti-tubercular therapy. But an alternate diagnosis was achieved later with invasive sampling and ATT was stopped. This case illustrates the need for physicians to remain alert to diseases which mimic tuberculosis in presentation.
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Affiliation(s)
- Arjun Lakshman
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Varun Dhir
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Narender Kumar
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
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Jin X, Yu J, Yan J, Chen S. Diffuse miliary nodules in the bronchial mucosa observed by bronchoscopy: sarcoidosis or tuberculosis? Clin Respir J 2015; 11:64-67. [PMID: 25918882 DOI: 10.1111/crj.12305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 03/08/2015] [Accepted: 04/21/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Miliary tuberculosis is a form of tuberculosis that is characterized by a wide dissemination into lung fields. So far, no report has shown a miliary tuberculosis case where diffuse miliary nodules can be observed in airways by bronchoscopy. Here we reported a case of military tuberculosis that can easily be misdiagnosed as sarcoidosis. METHODS Report of one case. RESULTS Bronchoscopy showed the presence of diffuse miliary nodules in the mucosa of bilateral bronchi. Pathological examination revealed non-caseating necrotic granuloma. Mycobacterium tuberculosis was not detected. Our case was extremely difficult to differentiate sarcoidosis from tuberculosis. With patient's safety in mind, we finally administered anti-tuberculosis therapy and obtained satisfactory results. CONCLUSION To our knowledge, this is the first report of a miliary tuberculosis case where diffuse miliary nodules were observed by bronchoscopy. Therefore, when diffused miliary nodules are observed during bronchoscopy, all of the patient's test results should be thoroughly analyzed to rule out miliary tuberculosis. If the diagnosis is very difficult, anti-tuberculosis therapy should be considered first to ensure patient safety.
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Affiliation(s)
- Xiaoyan Jin
- Pulmonary Department, Shanghai Tongren Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jialun Yu
- Pulmonary Department, Shanghai Tongren Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jin Yan
- Pulmonary Department, Shanghai Tongren Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shujing Chen
- Pulmonary Department, Shanghai Zhongshan Hospital affiliated to Shanghai Fudan University School of Medicine, Shanghai, China
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