121/291. Auramine orange stain with fluorescence microscopy is a rapid and sensitive technique for the detection of cervical lymphadenitis due to mycobacterial infection using fine needle aspiration cytology: a case series. OBJECTIVE: We sought to evaluate the effectiveness of the auramine orange (AO) stain in diagnosing mycobacterial cervical adenitis (MCA) from fine needle aspiration (FNA) cytology. methods: A retrospective review of 19 patients evaluated at 2 urban hospitals from 2000 to 2003 for suspected MCA. FNA specimens were inoculated to culture media and had direct smears stained by the auramine acid fast method. RESULTS: Mycobacteria were identified in 16 (84.2%) of 19 AO-stained FNA specimens, with results available within 4 hours. Corresponding cultures were positive for mycobacteria in 12 specimens, 9 tuberculous and 3 nontuberculous, and grew mycobacterium tuberculosis from the 3 AO-negative specimens. Three of the 4 patients with negative cultures had previously taken anti-mycobacterial medications. CONCLUSION: The AO stain with fluorescence microscopy is a sensitive and rapid method for detecting tuberculous and nontuberculous mycobacteria. It is a valuable tool for the otolaryngologists and pathologists in the diagnosis of MCA. ( info) |
122/291. A spectrum of coexistent tuberculosis and carcinoma in the breast and axillary lymph nodes: report of five cases. Tuberculosis (TB) and breast cancer are common diseases in developing countries. Their coexistence in the breast and axillary lymph nodes is, however, rare. It can lead to overstaging of the breast cancer. Treatment compliance may also be difficult when two major illnesses exist. Five cases of coexistent breast cancer and TB are presented with regard to presentation and outcome, with a review of the literature. ( info) |
123/291. Successful surgical treatment of an infrarenal abdominal pseudoaneurysm caused by tuberculosis: report of a case. A 76-year-old man was admitted to our hospital for investigation of an apparent abdominal aortic aneurysm detected during treatment for epididymitis. A chest X-ray showed miliary shadows in the bilateral lung fields strongly suggestive of tuberculosis. The diameter of the aneurysm increased, and examinations showed impending rupture of a pseudoaneurysm. However, a definitive disease pathogenesis was not obtained before surgery. We performed a subemergency operation, which revealed an infrarenal abdominal pseudoaneurysm caused by tuberculosis. The pseudoaneurysm appeared to have resulted from direct extension of tuberculous lymphadenitis to the aortic wall, which ruptured. We review 24 other cases of tuberculous aortic aneurysms surgically treated in japan before 2004. ( info) |
124/291. A case of tuberculous pyomyositis that caused a recurrent soft tissue lesion localized at the forearm. We present the case of a 20-year-old male who had a non-traumatic soft tissue lesion (4 x 3 cm) with recurrent discharge at his right posteromedial antebrachial muscles; the patient underwent surgery twice, and antibiotic therapy was administered, but no cure was achieved with these treatments. The patient underwent surgery at our medical center. There was no history of pulmonary, gastrointestinal, or genitourinary tuberculosis (TB). Due to suspected pulmonary, genitourinary, and gastrointestinal TB, radiography and computed tomography scans were performed, and these studies disclosed no evidence of a primary origin. The erythrocyte sedimentation rate and the results of purified protein derivate testing were normal. We also detected submandibular lymphadenopathy (LAP) (2 x 3 cm) localized at a submandibular site in our patient 4 months after his first visit to our clinic. Smears were stained with Ehrlich Ziehl Neelsen (EZN) stain and culture were grown for mycobacterium tuberculosis complex (MTC); the samples used for these assays had been obtained by incisional biopsy of the forearm lesion and by aspiration of the submandibular lymph node, and they were found to be MTC-positive. Then, a culture for MTC, derived from an induced sputum sample, was found to be positive, despite the negative results obtained with a sputum smear subjected to EZN staining. According to these results, the primary focus of the tuberculous pyomyositis and the submandibular LAP was the lungs. The lesion and submandibular LAP were both treated successfully by the administration of antituberculous chemotherapy. ( info) |
125/291. Tuberculous gluteal abscess coexisting with scrofuloderma and tubercular lymphadenitis. A 23-year-old man presented with diffuse swelling of the left buttock with overlying skin lesions associated with seropurulent discharge. There was no past history of tuberculosis. Routine investigations were normal and smears of the discharge for bacteria, fungi, and AFB were negative. However, culture of skin biopsy showed mycobacterium tuberculosis. skin and lymph node biopsy showed granulomatous inflammation suggestive of tuberculosis. Administration of antitubucular therapy led to complete resolution of the lesions within 12 months. ( info) |
| We report a case of dual mycobacterium tuberculosis (TB) and pneumocystis jiroveci (carinii) (PCP) lymphadenitis in a patient with hiv who had been receiving trimethoprim-sulfamethoxazole (TMP-SMX) as systemic prophylaxis for PCP. This patient was successfully treated with antituberculosis medications and TMP-SMX. Our review of the literature identified this as the first reported case of dual TB and PCP lymphadenitis in an hiv-infected host and highlights the potential limitations of TMP-SMX prophylaxis. ( info) |
127/291. Concurrent chronic myelogenous leukemia and tuberculous lymphadenitis: a case report. BACKGROUND: Double pathology is uncommon. The diagnostic effort must be directed toward uncovering a disorder that can explain all the findings in a given patient. However, exceptions occur, notably in the sphere of infectious disorders. This is particularly true in the context of multiple infections in immunocompromised patients. CASE: Fine needle aspiration was performed on 2 lymph nodes in a 22-year-old male. Extramedullary hematopoiesis was seen in 1, while the other showed acellular necrosis with acid-fast bacilli. The hematologic workup revealed chronic myelogenous leukemia. CONCLUSION: Extramedullary hematopoiesis can be a cytologic clue to hematologic disorders. A search for an additional infectious disease may be in order. ( info) |
128/291. Subungual erythema in lymph node tuberculosis with erythema nodosum. We encountered a case of tuberculous lymphadenitis with erythema nodosum presenting with an unusual manifestation as subungual erythema in all the digits. Relevant literature and the possible explanation for the subungual erythema have been discussed. ( info) |
| Tuberculous lymphadenopathy is often diagnosed and treated on clinical and cytopathological grounds as mycobacterium tuberculosis remains undetected in tissue specimens from such patients. At times, lymph nodes are known to respond sluggishly to and reappear during antitubercular therapy. We report a polymerase chain reaction-based approach to confirm the presence of M. tuberculosis in 4 such patients. ( info) |
130/291. An unusual presentation of extrapulmonary tuberculosis. A 22 years old female presented with fever, respiratory distress and a rapidly enlarging, soft left postauricular lump for last two months. She was found anaemic, had a right supraclavicular, non-tender lymph node of about 2.5 cm diameter and mild hepatosplenomegaly. She had a positive Mantoux test, and normal chest x-ray. ultrasonography of abdomen showed multiple pre-and para-aortic enlarged lymph nodes. Mild pericardial effusion was detected on echocardiography. Fine needle aspiration cytology from the right supraclavicular lymph node showed epithelioid cell granuloma. Excision and biopsy of the dermoid were carried out. The content was pus, which was smear-negative but culture-positive for acid-fast bacilli. The patient responded to antituberculous chemotherapy satisfactorily. ( info) |