Tubercular compound palmar ganglion presenting as a severe carpal tunnel syndrome- A case report

Atypical presentation of tuberculosis is not uncommon in developing countries. Among extra-pulmonary sites, tendons are very rarely involved. Compound palmar ganglion associated with tuberculosis is an uncommon condition in which a swelling is present across the wrist joint on either side of the flexor retinaculum. Very rarely such lesion can compress over neural structures and may present as Carpal Tunnel Syndrome. A therapeutic challenge consists of treating disease and its associated presentation. Treatment of choice for such conditions include complete excision of the mass along with the radical synovectomy of the wrist joint and associated flexor tendon sheaths followed by anti-tubercular medications. With early diagnosis and treatment good recovery can be achieved. We present a Case of a large compound tubercular palmar ganglion who presented to us with symptoms of carpal tunnel syndrome which was treated surgically with excision and carpal tunnel release.

Concurrent atypical diffused tuberculosis and macrorhabdosis in a canary (Serinus canaria)

A dead canary from a mixed species zoological garden was presented for diagnostic necropsy. Cachexia with prominent atrophy of pectoral muscles, yellowish brown discoloration of the liver and kidney, dark brown to black intestinal contents and moderate proventricular dilatation with some degree of catarrhal gastritis were the significant macroscopic findings. Parenchymatous organs like the liver, the spleen, the lung and the kidneys were extremely affected by massive diffuse necrosis and heavy infiltration of mononuclear inflammatory cells, histopathologically. Many giant bacilli resembling Macrorrhabdus ornithogaster were seen microscopically in the wet smear of the isthmus mucosa. Ghost-like unstained bacilli were revealed in the Giemsa stained contact smears of the liver and spleen. No typical mycobacterial granulomatous lesion was found in different tissues, but in Ziehl-Neelsen stained thin layer histologic sections from the liver, spleen, lung and kidney, numerous acid fast organisms were diffusely distributed. The case was diagnosed an atypical avian tuberculosis with concurrent macrorhabdosis. Mycobacterium sp. are capable of giving rise to a progressive disease in humans, especially in immunocompromised individuals. Cases of avian tuberculosis might be overlooked for lack of pathognomonic lesions suggestive of mycobacteriosis.

Tuberculosis of the lower lumbar spine with an atypical radiological presentation - a case mimicking a malignancy -

A 65-year-old woman was treated for an atypical radiological presentation of spinal tuberculosis. Compared with previously reported cases, the following two different radiographic features were found. 1) Although there was multiple and skipped involvement of the vertebral body, the intervertebral disc was relatively preserved. 2) The presence of an epidural granuloma indicated an epidural extension of the lesion of the adjacent vertebral body. These findings strongly mimicked bone marrow infiltrative disease such as a malignancy. Tuberculosis was confirmed through an open biopsy and the patient was treated successfully with antitubercular chemotherapy. This case highlights the importance of being aware that spinal tuberculosis has many different radiographic features and can mimic a spinal malignancy.