1/53. Dumbbell granulomatous abscess of the chest wall following needle biopsy of the pleura. A 38-year-old woman who had a Cope needle biopsy of the pleura was treated for plural tuberculosis on the basis of a positive PPD-S skin test and presence of caseating granulomas in the pleural biopsy. Ten months later she developed a tender, subcutaneous nodule in the area of the previous needle biopsy. Surgical exploration revealed a dumbbell abscess through the chest wall communicating with an area of consolidation in the right middle lobe. En bloc surgical resection of the abscess and peripheral portion of the right middle lobe was curative, although all pathologic and cultural studies of the resected tissue were non-diagnostic. ( info) |
2/53. Pseudochylothorax. Report of 2 cases and review of the literature. We report 2 cases of pseudochylothorax and review 172 published cases. Tuberculosis is by far the most frequent cause of pseudochylothorax, accounting for 54% of all caes, with a remarkable association with previous collapse therapy and long-term effusions. The remaining etiologies, including rheumatoid arthritis, are infrequent. Tuberculous pseudochylothorax is usually sterile. Successful treatment of an acute tuberculous pleurisy does not preclude the development of long-term complications such as pseudochylothorax. We do not recommend pleural biopsy initially because of its low yield for etiologic diagnosis. Currently, adenosine deaminase (ADA) values in pleural fluid are not useful to sustain diagnosis or therapeutic decisions. We advise draining only symptomatic cases and treating patients with positive Ziehl-Neelsen stain or Lowenstein culture, and those with growing effusions of suspected tuberculous origin, with antituberculous chemotherapy. Pulmonary decortication should be the last therapeutic step for recurrent and symptomatic cases. ( info) |
| A case of tuberculous pleurisy due to mycobacterium fortuitum in a 47-year-old woman with chronic granulocytic leukemia is described. The mycobacterial aetiology of the pleurisy was confirmed by pleural biopsy and by positive culture of M. fortuitum in pleural fluid. Antituberculosis chemotherapy with INH, RMP and EMB, combined initially with prednisolone, was successful in spite of total resistance of the strain to the drugs used. A short review of mycobacterioses and of recent literature on the topic, especially on M. fortuitum, is also presented. ( info) |
4/53. Mesothelial cells in tuberculous pleural effusions of hiv-infected patients. The scarcity of mesothelial cells is a well-known characteristic of tuberculous pleural effusions. We report three hiv-infected patients with tuberculous pleural effusions, in which mesothelial cells were found in significant numbers in the pleural fluid. Clinicians should be aware that the altered immune responses that occur in hiv-infected patients may affect the cytologic profile of tuberculous pleural effusions, and they should be cautious not to exclude this diagnosis based solely on the presence of mesothelial cells in the fluid. ( info) |
5/53. Atypical presentation of pleural tuberculosis: CT findings. Contrast enhanced CT examination of a 22-year-old male with pleuritic chest pain showed pleural-based nodular thickening and masses without any parenchymal involvement or mediastinal lymphadenopathy. Pathological examination following right parietal pleural decortication showed multiple granulomas with caseation necrosis typical of tuberculosis. Pleural tuberculosis presenting with multiple pleural nodules and masses without parenchymal involvement or lymphadenopathy has, to our knowledge, never been reported in the English literature. ( info) |
6/53. Tuberculosis of the breast presenting as carcinoma. breast infections caused by mycobacterium tuberculosis, although rare in western countries, should not be forgotten as a cause of a breast lump presenting clinically and radiologically as a carcinoma in the older patient who gives a history of previous tuberculosis. We report the case of an 84-year-old woman with a breast lump showing noncaseating granulomas on histology who developed a sinus track after excision biopsy of the lump. The patient responded to empiric treatment with anti-tuberculosis drugs and remains well 2 years after presentation. ( info) |
7/53. A 73-year-old man with chronic lymphocytic leukaemia and a haemorrhagic pleural effusion. A 73-year-old man presented with haemorrhagic pleural effusion, having been diagnosed with chronic lymphocytic leukaemia (CLL). The differential diagnosis of haemorrhagic pleural effusion is considered. Tuberculosis and pleural infiltration of CLL are considered most likely. Pleural biopsy confirms the diagnosis of pleural involvement of CLL in this case. Although pleural involvement of CLL has been reported several times the presentation of pleural effusion as the first symptom of CLL has not previously been described. ( info) |
8/53. Multiple pleural nodules without effusion--a rare presentation of tuberculous pleurisy. We report a rare case of tuberculous pleurisy presenting with multiple pleural nodules without associated effusion or parenchymal lung lesions. A 62-year-old man had multiple discrete pleural nodules in the right hemithorax on chest radiography without any clinical symptoms. Thoracoscopic biopsy of the pleural nodules revealed a caseous granuloma with acid-fast bacilli. The patient received antituberculous therapy, with resolution of tuberculomas on chest film within 2 months. To our knowledge, only two similar cases have been previously reported in the English literature, and our observation should lead to broadening of the spectrum of the differential diagnosis of multiple pleural nodules. ( info) |
9/53. Development of contralateral pleural effusion during chemotherapy for tuberculous pleurisy. Paradoxical worsening of tuberculous lesions, despite effective chemotherapy, has been reported in intracranial tuberculomas, lymph nodes, pulmonary disease, and tuberculous pleurisy. However, development of contralateral pleural effusion during treatment of tuberculous pleurisy is very rare. We report the case of a 22 year old female patient who presented with right sided pleural effusion and was treated with antituberculous drugs. Four weeks later although her right sided pleural effusion was subsiding she developed a left sided pleural effusion. Closed pleural biopsy on the left side showed granulomatous inflammation with early caseation. Antituberculous drugs were continued and a short course of oral prednisolone was added. She recovered completely and her chest x-ray became normal after finishing her treatment. ( info) |
10/53. Tuberculous pleurisy: an unusual complication during treatment of crohn disease with azathioprine. A patient is presented with crohn disease who developed tuberculous pleurisy while treated with azathioprine. The prevalence of opportunistic infections is discussed in patients with inflammatory bowel disease and treated with immunosuppressive regimes. ( info) |