Cases reported "Tuberculosis, Lymph Node"

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131/291. Clinics in diagnostic imaging (108). Tuberculous dactylitis of the thumb, mediastinal and left hilar lymphadenopathy, and probable left cervical lymphadenopathy.

    A five-year-old girl presented with a history of left neck swelling for one week and right thumb swelling for three weeks. Imaging studies revealed a "collar-stud" abscess in the left side of the neck, massive mediastinal lymphadenopathy with a left anterior chest wall abscess, and right thumb dactylitis that was typical of tuberculosis (TB). Surgical drainage of the left neck swelling revealed acid-fast bacilli. Young children are more susceptible to tuberculous infection, and at greater risk of extrapulmonary spread. A child infected with TB indicates recent transmission, usually from an adult. Good contact tracing is essential. Individuals with hiv infection are also at greater risk of TB and atypical mycobacterial infection as well extrapulmonary TB. The clinical and radiological features of both pulmonary and extrapulmonary TB are discussed, with additional illustrative cases. ( info)

132/291. Paradoxically developed optochiasmatic tuberculoma and tuberculous lymphadenitis: a case report with 18-month follow up by MRI.

    We report the first case ofextracranial tuberculous lymphadenitis which paradoxically developed during treatment of intracranial tuberculoma. Our patient, a 15-year-old girl who initially presented with meningitis and intracranial tuberculomas, developed extracranial tuberculomas during treatment for central nervous system tuberculosis. She was followed clinically with cerebrospinal fluid (CSF) studies and magnetic resonance imaging (MRI) at three monthly intervals. Within 18 months of specific antituberculous treatment, the patient had fully recovered. The course and response to therapy are discussed in light of the current literature. ( info)

133/291. Scrofuloderma neck with chest wall abscess.

    Cutaneous tuberculosis (TB) is among the uncommon varieties of tuberculosis but it is also on the rise, commensurate with the general resurgence of the disease. A case of scrofuloderma of neck with tuberculous abscess of anterior chest wall is, hereby, reported. The patient presented with a non-healing ulcer of neck with swelling of anterior chest wall, which responded to antituberculous treatment. This complication of scrofuloderma neck is very rare and should be kept in mind in the differential diagnosis of such lesions. ( info)

134/291. A boy undergoing maintenance hemodialysis who developed mediastinal lymph node tuberculosis.

    The incidence of tuberculosis (TBC) in patients undergoing maintenance hemodialysis is reported to be higher than that in the general population. We report an 8-year-old boy receiving such treatment for chronic renal failure who developed mediastinal lymph node TBC. He showed only intermittent fever, recurring every 2 weeks, with no other symptoms suggesting TBC. Although staining and culture of pharyngeal swab and gastric juice specimens failed to provide evidence of TBC, a lymph node biopsy specimen disclosed typical pathologic findings of tuberculoma, including caseating granulomas. Antituberculous therapy with isoniazid (INH), rifampicin, pyrazinamide, and ethambutol was given for 12 months, resulting in complete resolution of the TBC, with no subsequent recurrence. To our knowledge, mediastinal lymph node localization of TBC is relatively rare, in a patient on maintenance hemodialysis, especially in a child. ( info)

135/291. Tuberculous cervical lymphadenitis: an unusual case.

    A case is reported of a 52-year-old lady who presented with a swelling of the submental region of unknown aetiology mimicking a dental abscess. Following an excision biopsy of the lesion, the histopathology report revealed a mass of lymph nodes with granulomatous inflammation strongly suggestive of infective aetiology, most probably of mycobacterial (either tuberculosis or non-tuberculous mycobacteria (NTM)) origin. Cervical lymph node enlargement due to NTM remains a diagnostic challenge because of the inconsistent reliability of clinical and laboratory findings. We discuss the significance of caseating granulomatous inflammation in cervical lymphadenitis and provide a brief overview of tuberculosis and a comparison with NTM. CLINICAL RELEVANCE: Dental surgeons can play an important role in the diagnosis and early treatment of many systemic conditions and they should be aware of the signs and symptoms of tuberculosis, as this is now an increasingly common condition, particularly amongst the immigrant population. ( info)

136/291. Coexistent cervical tuberculosis and metastatic squamous cell carcinoma in a single lymph node group: a diagnostic dilemma.

    Primary cervical tuberculosis is uncommon, although its incidence has risen somewhat over the past few years. In this article, we describe a rare case in which the patient developed a dual pathology-cervical tuberculosis and a malignant squamous cell carcinoma-in a group of lymph nodes on one side of the neck. Initially, tuberculosis was diagnosed on the basis of histology and culture. However when the patient did not respond to antituberculous drug therapy, a repeat biopsy detected the second pathology: squamous cell carcinoma. To the best of our knowledge, no such presentation has been previously reported in the world literature. We conclude that repeat biopsy might be required in cases of tuberculous cervical lymphadenopathy that do not respond to conventional antituberculous therapy. ( info)

137/291. Immune reconstitution syndrome in a child with TB and hiv.

    Immune reconstitution syndrome (IRS) is the transient worsening or appearance of new signs, symptoms or radiological manifestation of an opportunistic infection occurring after the initiation of Highly active antiretroviral therapy (HAART) and is not due to treatment failure or new infection. We describe a case of a hiv infected child with tubercular (mediastinal) lymphadenitis with worsening of clinical and radiological features on starting HAART. ( info)

138/291. Case report of lymph nodal, hepatic and splenic tuberculosis in an hiv-positive patient.

    We describe a case of a male patient, 38 years old, hiv-positive (most recent CD4 count about 259/mm(3)), with abdominal pain, nausea, vomiting, anorexia, weight loss, and vespertine high fever with chills. His hemogram showed normocytic and normochromic anemia, with a high erythrocyte sedimentation rate (ESR) and gross granulations in the neutrophils. transaminases were normal. bone marrow biopsy evidenced a chronic disease anemia pattern and a lack of infectious agents. Abdominal ultrasound examination showed a normal-size spleen, which exhibited heterogeneous parenchyma and multiple small hypoechoic images, together with small ascites, peripancreatic and para-aortic lymphadenopathy. These findings were confirmed by abdominal CT. The liver was normal in size, but had a hyperechoic image, which was not visualized on CT. Histopathological analysis of one of the multiple abdominal lymph nodes obtained by laparoscopic biopsy exhibited a chronic granulomatous inflammatory process, with caseous necrosis. Tissue sections were positive for BAAR (acid-alcohol-resistant bacillus), and the cultures were positive for mycobacterium tuberculosis. Anti-tuberculosis treatment was begun, and the patient evolved with improvement of his general state, fever remission and weight gain. Splenic tuberculosis is a rare disease, occurring predominantly in patients in late stages of AIDS and/or disseminated tuberculosis. It is a difficult diagnosis, since there are no specific findings. Hence, complementary examinations, such as abdominal ultrasound/ CT, or fine needle aspiration, are usually necessary for investigation and differential diagnosis. Often, lesion regression after anti-tuberculosis regimens can be seen, and splenectomy is restricted to complicated or refractory disease. ( info)

139/291. Submandibular tuberculous lymphadenitis after endodontic treatment of the mandibular first premolar tooth: report of a case.

    Cervical tuberculous lymphadenitis (scrofula) is an infectious granulomatous disease that requires a precise diagnosis. The differential diagnosis involves mainly the pathologic conditions involving the regional lymph nodes and the submandibulary salivary glands. Although tuberculous lesions generally develop secondary to pulmonary disease, clinical manifestations are occasionally seen with no evidence of involvement of the lungs. In this report, a case of tuberculous submandibular lymphadenitis developing after endodontic treatment of the mandibular first premolar tooth is described. ( info)

140/291. Tuberculous hilar lymph nodes leading to tracheopulmonary artery fistula and pseudoaneurysm of pulmonary artery.

    Tracheopulmonary artery fistula is an extremely rare condition. We report the case of an 80-year-old man who presented with massive hemoptysis. He was found to have tuberculous mediastinal lymph nodes that had eroded into the pulmonary artery and anterior tracheal wall, leading to a pseudoaneurysm of the right pulmonary artery and a tracheopulmonary artery fistula. ( info)
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