1/16. Disseminated BCG infection following bone marrow transplantation for X-linked severe combined immunodeficiency.An 8-month-old boy with X-linked severe combined immunodeficiency (XSCID) developed disseminated bacille Calmette-Guerin (BCG) infection following BCG vaccination at birth. He initially presented with an abscess at the site of BCG vaccination and was begun on three-drug antituberculous treatment (rifampicin, isoniazid, and pyrazinimide). Dissemination was subclinical prior to a human leukocyte antigen (HLA)-identical bone marrow transplant (BMT) from his sister, following which he presented with an acute erythroderma. A skin biopsy specimen revealed granulomas with epithelial histiocytes and giant cells in the reticular dermis, and numerous acid-fast bacilli (AFB) were present on Ziehl-Nielsen stain. A diagnosis of disseminated BCG disease was made. Despite the addition of a fourth antituberculous agent, ethambutol, he did not recover and developed numerous skin abscesses over the following weeks. Examination of pus from these lesions demonstrated numerous AFB. clarithromycin was added as a fifth antituberculous agent. Despite five-drug antituberculous therapy and monthly intravenous immunoglobulin infusions, recurrent abscesses containing AFB developed intermittently until 7 months posttransplant. At follow-up 1 year post-BMT he showed good general physical improvement. All abscesses had healed with scarring, and no further skin lesions had occurred.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/16. Cytologic features of disseminated bacillus Calmette-Guerin (BCG) infection.Disseminated bacillus Calmette-Guerin (BCG) infection is an unusual complication of immunization against mycobacterium tuberculosis with the bacillus Calmette-Guerin. We report on 4 such cases in which the diagnosis was suspected at the fine-needle aspiration biopsy (FNAB) procedure. Participants were 4 males (mean age, 21.5 mo; range, 8-36 mo) in good general condition, in whom epidemiology data favoring tuberculosis and presence of pulmonary tuberculosis were lacking. Cases 1 and 2 presented with a deep-seated subcutaneous nodule located near the left mamilla and lower aspect of the left scapula, respectively, resulting from lymph node involvement by BCG. Cases 3 and 4 presented as an osteolytic lesion of the ninth right rib and right iliac bone, respectively. FNAB findings showed poorly to moderately cellular smears. Epithelioid histiocytes in a granuloma pattern with occasional multinucleated Langerhans-type giant cells, lymphocytes, and polymorphonuclear leukocytes in a finely granular background with necrotic debris were found in all cases. The presence of isolated calcified spherules interspersed among the cells was found to be a useful finding for diagnosis. When dealing with disseminated BCG infections, clinical and cytological pictures must be evaluated as a whole in order to arrive at an accurate diagnosis.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
3/16. Tuberculosis of oral mucosa.In secondary tuberculosis, lesions of the oral cavity may accompany lesions of the pharynx, lungs, lymph nodes or miliary tuberculosis. A 35-year-old male was suffering from swelling of his right cheek, cough, weakness and weight loss. There were local hyperemia and irregular oral mucous in the inner part of the right cheek. Chest x-ray showed bilateral nodular opacifications and a cavity of 2 cm. Acid-fast bacteria were present in sputum and Lowenstein-Jensen culture was positive. The pathological signs of the biopsy taken from the buccal mucosa including multistratified squamous epithelium were: tubercle structure, Langhans' giant cells and minimal cazeation necrosis. After anti-tuberculous chemotherapy oral and pulmonary lesions were almost in remission. Following this case report of lung tuberculosis accompanied by tuberculosis of oral mucosa, the literature related is reviewed.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
4/16. Rare co-existence of salmonella typhi and mycobacteria tuberculosis in a psoas abscess--a case report.We report a rare case of dual infection in a psoas abscess. Pus from the abscess grew salmonella typhi and the abscess wall showed epitheloid granulomas giant cells, which we confirmed as tuberculosis by PCR. Such dual infection cases may be missed unless looked for since both these infections are common in our country.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
5/16. Esophageal tuberculosis presenting with an appearance similar to that of carcinoma of the esophagus.A case of esophageal tuberculosis presenting with an appearance similar to that of esophageal cancer is reported. The patient was an 82-year-old man with progressive dysphagia. barium swallow and esophagoscopy revealed an elevated lesion with deep ulceration in the middle thoracic esophagus. Esophageal carcinoma, in particular, an undermining type of undifferentiated carcinoma, was suspected fluoroscopically and endoscopically. Histological examination of biopsy specimens revealed no malignancy, but there were epithelioid granulomas and a few Langhans' type multinucleated giant cells. Endoscopic ultrasonography clearly demonstrated an extramural lesion with calcification and direct infiltration of enlarged subcarinal lymph nodes into the esophageal wall. Ultrasonographic and histological findings indicated the possibility of esophageal tuberculosis. Although no bacteriological evidence was obtained, a therapeutic trial for tuberculosis, using antituberculous drugs, was started. After 2 weeks, the enlarged subcarinal lymph nodes were markedly reduced in size. The patient's symptoms improved gradually and had disappeared 8 weeks after he started treatment, when tubercle bacilli were isolated from sputum. A connection between the esophageal wall and its adjacent structures was clearly demonstrated by endoscopic ultrasonography. For patients with findings indicative of esophageal tuberculosis on endoscopic ultrasonography, a therapeutic trial for tuberculosis should be considered, even if polymerase chain reaction assay or culture is negative.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
6/16. Abdominal tuberculosis with pancreatic involvement: a case report.A case of abdominal tuberculosis with pancreatic involvement is described. A 27-year-old Italian male, with no known cause of immunodeficiency and with no evidence of pulmonary tuberculosis, was admitted to our division because of acute pancreatitis. Abdominal imaging revealed a large 'tumour-like' mass in the pancreas head compressing the distal choledochous, and multiple adenopathy. Histological examination of multiple specimens removed during explorative laparotomy revealed granulomas with giant cells, caseous necrosis, and positive Ziehl-Neelsen staining. Tissue culture was positive for mycobacterium tuberculosis. Once specific medical treatment was started, the pancreatic damage completely resolved.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
7/16. Primary esophageal tuberculosis.A case of primary esophageal tuberculosis in a young male is hereby reported who presented with epigastric pain and dysphagia. An esophageal ulcer was seen at 29 cm level, and tuberculosis was confirmed by the presence of caseating granulomas and Langhan's giant cells. He responded well to antituberculous treatment.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
8/16. Case report of tuberculous panophthalmitis.BACKGROUND: Although tuberculosis is very common in the Indian sub-continent, tuberculous panophthalmitis has not been reported from this region so far. We report a case of a young girl with tuberculous panophthalmitis. CASE REPORT: A 12-year-old female child presented with painless progressive loss of vision in the right eye of two months' duration. Examination revealed diffuse corneal haze with deep vascularization, iris nodules, and scleral necrosis. Histopathological examination of the enucleated eye revealed necrotizing granulomatous inflammation, multiple epitheloid cell granulomas, and Langhan's giant cells, along with large areas of caseous necrosis. Chest X-ray revealed right hilar lymphadenopathy with right lower zone infiltration and a small pleural effusion. Considering the clinical picture, histopathology and chest findings, a diagnosis of disseminated tuberculosis was made, and standard four-drug anti tubercular treatment was started. At 2 months follow up there was radiological resolution of the lung lesions and pleural effusion. CONCLUSIONS: Clinical features suggestive of tubercular panophthalmitis are absence of pain, presence of nodules on or within the eyeball, and spontaneous perforation. We would like to emphasize that in all susceptible individuals presenting with clinical suspicion of ocular tuberculosis it would be prudent to start early anti-tubercular therapy to prevent progression to panophthalmitis. A complete systemic workup to look for any other possible focus of tubercular involvement must be done.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
9/16. rifampin-induced hypothyroidism.Three euthyroid patients with Hashimoto's thyroiditis developed hypothyroidism after the administration of rifampin. We studied 67 patients with tuberculosis. All of them were treated with rifampin. Of the 67 patients, 42 had negative tests for anti-thyroid antibodies (ATA) and 25 had positive tests for ATA. The diagnosis of Hashimoto's thyroiditis was made on the basis of positive tests for ATA. After the administration of rifampin, TSH levels were not significantly altered in all of the former 42 ATA-negative patients and in 22 of the latter 25 ATA-positives, but TSH levels increased in the other three (patients 1, 2 and 3) of the latter 25 ATA-positives. Three euthyroid Hashimoto's patients (patients 1, 2 and 3) developed hypothyroidism after the administration of rifampin. This rifampin-induced hypothyroidism resolved in each, once rifampin was discontinued. A) Patient 1: a 62-yr-old man with lymphoma had pulmonary tuberculosis. After the administration of rifampin, serum TSH increased to 170 mU/l; B) Patient 2: a peritoneal-biopsy specimen containing Langhans' giant cells led to a diagnosis of tuberculous peritonitis in a 66-yr-old woman with ascites. After the administration of rifampin, TSH increased to 12.4 mU/l; C) Patient 3: a 56-yr-old woman with a liver abscess and lymphadenopathy underwent lymph-node biopsy that showed mycobacterium tuberculosis with caseating granulomas. After the administration of rifampin, TSH increased to 21.3 mU/l. After its administration, patients 1, 2 and 3 developed hypothyroidism, and received T4. When rifampin was discontinued, the hypothyroidism resolved. After the course of rifampin-therapy had been completed, T4 was discontinued. At-risk patients who receive rifampin may become hypothyroid.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
10/16. Human lingual tuberculosis. An ultrastructural study.According to morphological criteria, the predominant cells from human oral tuberculosis granulomas are classified as monocytes, epithelioid cells, and multinucleated giant cells. The morphology of each cell type is related to its speculated function. It is theorized that macrophages and epithelioid cells represent an in vivo line of differentiation from undifferentiated monocytes and that giant cells form from a coalescence or syncytium of macrophages. The role of these phagocytic cells and other participating inflammatory cells in granulomatous inflammation is discussed.- - - - - - - - - - ranking = 2keywords = giant (Clic here for more details about this article) |
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