Cases reported "Tuberculosis, Endocrine"

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1/53. Disseminated tuberculosis: still a diagnostic challenge.

    Disseminated tuberculosis is notoriously difficult to diagnose and, with the decrease in tuberculosis incidence in australia, familiarity with its manifestations has dwindled. We describe four bacteriologically proven cases which illustrate the range of presentations and diagnostic difficulties. Surprisingly, immunosuppressive therapy need not cause rapid deterioration. Disseminated tuberculosis should be considered in any patient with multisystem illness who is at risk of tuberculosis, particularly if born overseas. In the absence of confirmatory results, a prompt therapeutic trial may be life-saving. ( info)

2/53. Unusual presentation of tuberculosis reactivation in childhood: an anterior neck mass.

    Although extrapulmonary tuberculosis has a broad spectrum of clinical manifestations, involvement of the thyroid gland in children has been reported very rarely. The authors report a case of an 11-year-old girl with a nontender nodular swelling of the thyroid, whose symptoms, tomographic and scintigraphic features, mimicked a nodule with a cystic component. Although seldom observed, tuberculosis should be considered in the differential diagnosis of nodular lesions of the thyroid in children, especially in the patient with known history of exposure to tuberculosis. ( info)

3/53. Tubercular involvement of the thyroid gland: a report of two cases.

    Thyroid tuberculosis is rare. In the last decade, however, the incidence of extrapulmonary forms of tuberculosis has increased. We report on 2 cases of thyroid tuberculosis. In case 1, a tubercular abscess mimicking acute thyroiditis was found which was correctly diagnosed by fine-needle aspiration biopsy (FNAb). No evidence of active disease was noticed. Pleural thickening on chest X-ray was the only sign compatible with a previous infection. In case 2, tubercular thyroiditis with lymph node enlargement was also diagnosed by FNAb in a reevaluation setting. In both cases treatment with antitubercular drugs resulted in complete recovery. Thyroid tuberculosis should be kept in mind in the differential diagnosis of thyroid nodules, notably in patients with a history of tuberculous disease. FNAb represents the main approach to making the diagnosis. ( info)

4/53. Disseminated tuberculosis causing bilateral adrenal enlargement and Addison's disease.

    The clinical features and computed tomography imaging of a patient with acute adrenal failure following disseminated tuberculosis is described. ( info)

5/53. US and CT findings of tuberculosis of the thyroid: three case reports.

    With two ultrasonographic and two CT films of three cases of thyroid tuberculosis, we evaluate the ultrasonographic and CT findings and correlate them with the pathologic findings. They are demonstrated as heterogeneous hypoechoic mass on ultrasonogram and peripheral-enhancing low-density abscess on CT scan with regional lymphadenopathy. ultrasonography (US) and CT can help the diagnosis of thyroid tuberculosis. ( info)

6/53. Pituitary tuberculoma mimicking adenoma: magnetic resonance imaging.

    A case of a pituitary mass with clinical and MRI findings consistent with adenoma is presented. Transnasal transphenoidal excision biopsy showed it to be a pituitary tuberculoma. The patient was treated with antituberculous drugs, and a follow-up MRI 18 months later showed good response. MRI features and a review of published reports of the sellar tuberculoma are briefly discussed. ( info)

7/53. Solitary pancreatic tuberculosis mimicking advanced pancreatic carcinoma.

    A 40-year-old woman was referred for pancreatic head carcinoma invading the portal vein. The dichotomy between the radiological findings and the general condition of the patient, as well as the laboratory results (no evidence of cholestasis), cast doubt on the diagnosis. There was no history of tuberculosis. The chest radiograph revealed no pathological findings. The anatomic relationships of the lesion entailed a high risk of vascular injury if tissue biopsy were to be done; therefore, diagnostic laparotomy was performed. biopsy revealed granulomas with caseous necrosis, consistent with tuberculosis. After 6 months of antituberculosis treatment, the lesions had completely resolved. Tuberculosis should be considered in the differential diagnosis of pancreatic masses, particularly in regions where the disease is endemic. The condition usually resembles an advanced pancreatic tumor. Performing a biopsy of inoperable lesions and maintaining a reasonable skepticism in regard to the evaluation of operable lesions (attention to nonexclusive but helpful clues, such as young patient age, history of tuberculosis, absence of jaundice) will lead to the diagnosis in most patients. Diagnostic laparotomy may be required in a small subset of patients. The response to antituberculosis treatment is very favorable. The role of resection (e.g., pancreatoduodenectomy) is very limited. ( info)

8/53. Tuberculous granulomatous inflammation associated with adenoma of parathyroid gland manifesting as primary hyperparathyroidism.

    A 36-year-old female presented with generalized bone pain, muscular weakness and enlarged cervical lymph nodes. The biochemical findings and skeletal survey was suggestive of primary hyperparathyroidism (PHPT). CT of neck and thorax showed enlarged multiple lymph nodes in the cervical and superior mediastinal region. With a diagnosis of PHPT she underwent cervical exploration and excision of enlarged right inferior parathyroid gland along with biopsy of nodes were done. Histopathology revealed the features of right parathyroid adenoma with few foci of epithelioid granuloma and granulomatous lymphadenitis. AFB smear and culture sensitivity was negative. A positive PCR for mycobacterium tuberculosis of the homogenates of parathyroid tumor confirmed tuberculous inflammation within the parathyroid adenoma. To the best of our knowledge this is the first reported case of parathyroid adenoma associated with tuberculous pathology in a case of PHPT. ( info)

9/53. hypercalcemia in a patient with tuberculous adrenal insufficiency.

    OBJECTIVES: To raise awareness of hypercalcemia as a rare and at times inaugural manifestation of adrenal insufficiency. CASE REPORT: Evaluation of hypercalcemia in a 43-year-old man showed adrenal insufficiency. Biopsies of the testes and adrenal glands revealed epithelioid and giant cell lesions indicating tuberculosis. Although tuberculosis can contribute to hypercalcemia, this possibility was ruled out in our patient by the low serum 1,25-dihydroxy-vitamin D3 levels and return to normal of serum calcium and renal function under hormone replacement therapy. It should be noted, however, that a course of pamidronate was given. CONCLUSION: The mechanism of hypercalcemia associated with adrenal insufficiency is controversial. hyperparathyroidism was ruled out in our patient. adrenal insufficiency should be considered in some patients with hypercalcemia. ( info)

10/53. Sonographic findings of tuberculous thyroiditis in a patient with Behcet's syndrome.

    We report a case of tuberculous thyroiditis in a woman with Behcet's syndrome. The initial physical examination in May 1998 revealed multiple soft, nontender, mobile lymph nodes, each measuring less than 1 cm, in the left lower internal jugular chain. Sonography performed in February 2000 showed multiple small (< 1 cm), oval lymph nodes, each with an intact fatty hilum, in the left lower internal jugular chain; the thyroid gland appeared normal. Follow-up sonography 6 months later showed multifocal, heterogeneous, hypoechoic lesions with ill-defined margins in both lobes of the thyroid and several small, oval lymph nodes, each with an intact fatty hilum, in the left lower internal jugular chain. Fine-needle aspiration was performed on the largest thyroid lesion, and cytologic analysis of the aspirate revealed a small number of epithelioid histiocytes in a necrotic background, which was suggestive of tuberculosis. Follow-up sonography after 3 months of antituberculosis chemotherapy showed that the thyroid lesions had resolved. ( info)
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