Cases reported "Tuberculosis, Pleural"

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1/34. 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.
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ranking = 1
keywords = tuberculosis
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2/34. Tuberculosis pleurisy due to mycobacterium fortuitum in a patient with chronic granulocytic leukemia.

    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.
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ranking = 1
keywords = tuberculosis
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3/34. 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.
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ranking = 6
keywords = tuberculosis
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4/34. 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.
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ranking = 3
keywords = tuberculosis
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5/34. Discrete pleural nodules associated with a parasternal mass: an unusual manifestation of tuberculosis.

    SUMMARY: The case presented describes an unusual appearance of thoracic tuberculosis with multiple pleural nodules associated with a parasternal mass as depicted on computed tomography. The patient is a 22-year-old woman who presented with pleuritic chest pain, a left parasternal mass, and weight loss. The pleura of the left hemithorax was studded with multiple low-attenuation, rim-enhancing nodules, and a left parasternal mass with similar imaging features was seen anterior to an enlarged left internal mammary lymph node. There were no pulmonary parenchymal changes nor any mediastinal or hilar lymphadenopathy. Cytologic examination of the specimen obtained with fine needle aspiration of the pleural and parasternal masses yielded granulomatous inflammation. The symptoms remitted with antituberculous chemotherapy and a follow-up CT obtained 6 months later showed complete resolution of the pleural nodules and parasternal mass and considerable regression of the left internal mammary lymph node. Involvement of the pleura with discrete nodules in the absence of parenchymal changes or mediastinal lymphadenopathy is rare in tuberculosis. To the best of the present authors' knowledge, the combination of a tuberculous parasternal mass and multiple pleural nodules as the sole manifestations of thoracic tuberculosis has not been reported previously.
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ranking = 7
keywords = tuberculosis
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6/34. Increased pleural fluid adenosine deaminase in brucellosis is difficult to differentiate from tuberculosis.

    Pleural involvement in brucellosis is very rare. Current knowledge on brucella pleuritis is limited to a few case studies, and pleural adenosine deaminase (ADA) in brucellosis has not been studied previously. We report the pleural fluid characteristics, including ADA, of two cases with brucella pleurisy. Analysis of the pleural fluids revealed exudative effusions with increased ADA level, decreased glucose concentration, and lymphocyte predominance. The similarity with tuberculous pleurisy was remarkable. We suggest that brucellosis should be considered in the differential diagnosis of tuberculosis, especially in regions endemic for both diseases.
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ranking = 5
keywords = tuberculosis
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7/34. Tuberculosis of the endothoracic fascia.

    A 13-year-old boy presented with a history of respiratory infection that had progressed for 3 months. A chest X-ray showed pathological findings that suggested endothoracic fascia compromise (Skarby sign). The thorax computerized axial tomography scan revealed multiple opacities in the fascia. A biopsy was performed, and a pathological lymph node with caseous material was obtained. Thirty days later, mycobacterium tuberculosis var. hominis was obtained from the culture. The diagnosis of tuberculosis of the endothoracic fascia was confirmed. Treatment included 9 months with isoniacide and rifampin, and 2 months with pirazynamide and streptomycin, with excellent response. Vitamin B6 was added.
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ranking = 2
keywords = tuberculosis
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8/34. Relapse of tuberculosis in a patient with the acquired immunodeficiency syndrome despite 12 months of antituberculous therapy and continuation of isoniazid.

    A 33-year-old man with AIDS and pleuro-pulmonary tuberculosis was treated with a combination of antituberculous medications for 12 months and with continuation of isoniazid. A total of 2 months after completing combination therapy the patient developed fever, malaise, and anorexia. Mycobacterial blood cultures grew M. tuberculosis and the patient improved with the readministration of rifampicin and pyrazinamide. Phage typing of the patient's isolates of M. tuberculosis confirmed that he had experienced a relapse and not a reinfection. The patient had received 5 months of his treatment while hospitalised. We believe he was compliant with therapy outside the hospital because he attended all of his clinic appointments. follow-up studies of hiv-infected patients with tuberculosis are therefore needed.
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ranking = 8
keywords = tuberculosis
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9/34. Tuberculosis in a contact.

    A 12 year old girl developed a large tuberculous pleural effusion. She was a contact of an adult with pulmonary tuberculosis who was positive on smear testing, and she had been managed in accordance with current British Thoracic Society recommendations.
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ranking = 1
keywords = tuberculosis
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10/34. pleural effusion associated with aortitis syndrome.

    A patient with aortitis syndrome had a pleural effusion which subsided but reappeared with an exacerbation of aortitis symptoms while under antituberculosis treatment. The character of the fluid was that of an exudate, and the glucose concentration was normal. Clinical and laboratory features of the case suggest that the effusion was part of the aortitis syndrome per se.
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ranking = 1
keywords = tuberculosis
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