Cases reported "Tuberculosis"

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1/61. familial mediterranean fever. No role of mycobacterium tuberculosis in ten patients.

    BACKGROUND: Tuberculosis (TB) and familial mediterranean fever (FMF) are two common diseases in our region, turkey. Both share some properties in common: Both cause AA type amyloidosis and have association with some immunological abnormalities. Upon incidentally observing mycobacterium tuberculosis in bone marrow biopsies of three patients with FMF in a previous study, we intended to elucidate this association prospectively. MATERIAL AND methods: In this study, we examined prospectively 10 FMF patients, 5 male and 5 female, with a median duration of 31 years disease activity. All were under colchicine therapy. They had no sign of renal involvement. The bone marrow biopsies of these patients were examined for the presence of M. tuberculosis by polymerase chain reaction (PCR), BACTEC culture and pathological stains. Pathological examination was performed for the existence of granuloma and amyloid deposition by hematoxylin-eosin, Crystal Violet and congo red stains. RESULTS: The examination of all bone marrow specimens by the mentioned methods suggest that mycobacterium tuberculosis has no role in the ethiopathogenesis of FMF. Although the patients had a positive family history of 60% for tuberculosis and in 80% of them with positive tuberculin skin test. CONCLUSIONS: We concluded that although there seemed to be a kind of association between both diseases, this relationship is not via the direct existence of bacteria itself. Considering high family history and skin test positivity, one should look for the presence of autoimmune mechanisms under this suspicious relationship between tuberculosis and FMF. Also, this is the first study examined the state of amyloidosis in the bone marrow at an earlier stage of FMF without overt renal findings.
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keywords = bone
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2/61. mycobacterium tuberculosis infection in allogeneic bone marrow transplantation patients.

    Bone marrow transplant (BMT) recipients are prone to bacterial, viral and fungal infections. mycobacterium tuberculosis infection can occur in these patients, but the incidence is lower than that of other infections. This report describes four patients with mycobacterium tuberculosis infection identified from 641 adult patients who received a BMT over a 12-year period (prevalence 0.6%). The pre-transplant diagnosis was AML in two patients and CML in the other two. Pre-transplant conditioning consisted of BU/CY in three patients and CY/TBI in one. Graft-versus-host disease (GVHD) prophylaxis was MTX/CsA in three patients and T cell depletion of the graft in one patient. Sites of infection were lung (two), spine (one) and central nervous system (one). Onset of infection ranged from 120 days to 20 months post BMT. Two patients had co-existing CMV infection. One patient had graft failure. The two patients who received anti-tuberculous (TB) therapy recovered from the infection. Although the incidence of tuberculosis in BMT patients is not as high as in patients with solid organ transplants, late diagnosis due to the slow growth of the bacterium can lead to delay in instituting anti-TB therapy. A high index of suspicion should be maintained, particularly in endemic areas.
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keywords = bone
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3/61. CT findings in tuberculous otomastoiditis. A case report.

    PURPOSE: Otomastoiditis is a rare but important manifestation of tuberculosis and is well recognizable when information on its clinical course is considered in connection with the radiographic changes. MATERIAL AND METHOD: A patient with a clinical history of chronic otorrhea, resistant to conventional therapy but without dramatic symptoms, was referred for CT examination. RESULTS: CT revealed widespread soft tissue densities in the tympanic cavity and in the mastoid process, with bone erosions in the latter. Surgery and bacteriology confirmed the diagnosis of mycobacterium tuberculosis infection. CONCLUSION: CT evidence of widespread bone destruction without clinical signs of aggressive infection should suggest the diagnosis of a mycobacterial process. Early treatment is essential in order to avoid propagation of the disease and lasting loss of function.
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4/61. Hemophagocytic syndrome as an unusual form of presentation of tuberculosis in a hemodialysis patient: case report and review of the literature.

    We present an unusual manifestation of tuberculosis in a patient on hemodialysis. A 73-year-old woman was admitted to our hospital with a picture of fever, dyspnea and weight loss. She had chronic renal failure and had started periodic hemodialysis 5 years before. Fifteen days after admission, she began with pancytopenia, abnormal liver function and coagulopathy. A bone marrow aspiration was made 1 week later showing macrophage elements with phagocytic activity. Eight weeks later, bone marrow culture in Lowenstein media confirmed the presence of tuberculosis. After the beginning of antituberculosis therapy, the laboratory disturbances disappeared and the clinical situation improved. We think that fever of unknown origin and pancytopenia in patients on maintenance hemodialysis must lead to an early bone marrow biopsy or aspiration since after the diagnosis a specific therapy can cure the disease.
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keywords = macrophage, bone
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5/61. 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.
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keywords = bone
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6/61. Disseminated bacille Calmette-Guerin infection in an infant with a novel deletion in the interferon-gamma receptor gene.

    Six weeks after receiving BCG vaccination, a Canadian aboriginal infant presented with suspected sepsis, lymphadenopathy and hepatosplenomegaly. Lymph node biopsy revealed macrophages filled with acid-fast bacilli. mycobacterium bovis was cultured from tissue specimens and there was evidence of concomitant cytomegalovirus disease. The infant died of disseminated BCG infection. A novel deletion at nucleotide 165 in the interferon-gamma receptor (IFN-gammaR1) was identified. The incidence of this mutation in the aboriginal population and the impact on the heterozygous state are unknown.
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ranking = 23.680112298348
keywords = macrophage
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7/61. Severe disseminated BCG infection in an 8-year-old girl.

    An 8-year-old girl died of sepsis due to staphylococcal infection one year and 8 months after Bacille Calmette-Guerin (BCG) revaccination. Two months after the vaccination in accordance with the school health program, she was hospitalized with a high fever, skin rash over the face and lower limbs, and leukopenia. Her clinical and laboratory pictures were not compatible with those of any established type of immunodeficiency. The polymerase chain reaction (PCR) test for M. tuberculosis complex was positive for bone marrow, pleural fluid, and peripheral blood. The strain recovered from a mycobacterial culture of the blood was identical to the BCG strains with which the patient was vaccinated, based on restriction fragment length polymorphism (RFLP) and a pulse-field gel electrophoresis (PFGE) analyses of dna. She developed finally a lung abscess due to staphylococcal septicemia, which was the direct cause of her death.
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ranking = 0.25
keywords = bone
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8/61. Fatal sepsis due to mycobacterium tuberculosis after allogeneic bone marrow transplantation.

    mycobacterium tuberculosis is a serious, but rare infectious complication after allogeneic bone marrow transplantation. We describe a case of fatal sepsis due to mycobacterium tuberculosis after allogeneic bone marrow transplantation for philadelphia chromosome-positive ALL. The diagnosis was made after BAL. Although broad-spectrum antituberculous therapy was started immediately after diagnosis, blood cultures became positive for mycobacterium tuberculosis. The patient developed severe pyrexias and finally died of multi-organ failure. Rapid progression of mycobacterial infection should be considered in patients post BMT with unexplained fever, particularly in patients from endemic areas.
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ranking = 1.5
keywords = bone
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9/61. 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.
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ranking = 0.25
keywords = bone
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10/61. Sinonasal tuberculosis associated with osteomyelitis of the ethmoid bone and cervical lymphadenopathy.

    Sinonasal tuberculosis is a rare disease; its association with osteomyelitis of surrounding bone and cervical lymphadenopathy has been reported rarely. In this article, we report a case of sinonasal tuberculosis that was complicated by osteomyelitis of the ethmoid bone and cervical lymphadenopathy. infection of the bone was demonstrated by biopsy and (99m)Tc-MDP bone single photon emission computed tomography (SPECT), and cervical lymphadenopathy was confirmed by histology. This case will be discussed with specific emphasis on the imaging characteristics.
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ranking = 2
keywords = bone
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