141/291. An unusual case of active tuberculosis of the oesophagus in an adult. A case is reported of a 56-year-old woman of Libyan origin presenting with dysphagia, retrosternal pain and weight loss. Oesophago-gastroduodenoscopy revealed an ulcerated tumor in the upper oesophagus strongly suggesting a malignancy. A positive Mendel-Mantoux test along with histological evidence of epitheloid cell granulomas and clinical findings consistent with pulmonary and lymph node tuberculosis led to the presumptive diagnosis of oesophageal tuberculosis. The diagnosis was later confirmed by positive bacteriological cultures of oesophageal biopsies and gastric washings. It is very unusual for dysphagia to be the presenting symptom of active adult tuberculosis. Oesophageal tuberculosis is extremely rare and must be distinguished predominantly from oesophageal carcinoma. ( info) |
142/291. Tuberculosis of the parotid gland: a case report. A case of tuberculosis of the parotid gland, which involved the intraparotid lymph nodes of a 39-year-old Thai man is reported. The histologic characteristics of caseating granulomas with presence of acid and alcohol fast bacilli were criteria for diagnosis. This case is thought to be the first report of tuberculosis of the parotid gland in thailand. ( info) |
143/291. Isolated intrathoracic tuberculous lymphadenopathy. We report an 82 yr old man with isolated intrathoracic lymphadenopathy of tuberculous origin, which is an extremely uncommon presentation of tuberculosis especially in elderly Caucasian patients. The diagnosis was suggested by the computerized tomographic (CT)-scan showing central hypodense areas after contrast, and was subsequently proved by mediastinoscopic biopsy with histological and microbiological analysis. The atypical presentation of tuberculosis together with a negative two-step 5 international units of purified protein derivative (IU-PPD) tuberculin skin test and a frequent contact with a cavernous index case points towards a primary infection in this patient. ( info) |
144/291. An unusual cause of cervical lymphadenitis: Kikuchi-Fujimoto disease. Cervical lymphadenitis may be the result of diverse conditions in a patient. Clinical and epidemiologic information about cervical lymphadenitis can often lead to a presumptive diagnosis and, thus, limit the number of studies required as well as direct the type of initial therapy administered. We report a case of cervical lymphadenitis in a Vietnamese woman for whom a presumptive diagnosis of tuberculosis was made and antituberculous therapy was started. Pathologic examination of an excised lymph node revealed the correct diagnosis--histiocytic necrotizing lymphadenitis, or Kikuchi-Fujimoto disease. We review the clinical, epidemiologic, and pathologic features of this recently recognized disease. Careful examination of excised material from the lymph nodes should prevent patients who have Kikuchi-Fujimoto disease from receiving unnecessary treatment. ( info) |
145/291. Case report 654: Disseminated tuberculosis. A case of disseminated tuberculosis with a psoas abscess and associated destruction of bone in a 28-year-old man has been presented. Multiple skeletal lesions and hilar adenopathy were observed. The initial diagnosis from pathological specimens was equivocal, since acid-fast bacilli were not demonstrated. However, special stains of biopsy specimens subsequently confirmed the diagnosis. The initial radiographs suggested disseminated malignancy. Good therapeutic results were obtained, utilizing surgical and chemotherapeutic methods. This case demonstrates the ability of disseminated tuberculosis to mimic other disease processes and shows the difficulty that may exist in establishing a diagnosis of tuberculosis, even with biopsy specimens. ( info) |
| The intrahepatic biliary tree can occasionally be infected by mycobacterium tuberculosis, but tuberculosis of the common bile duct has not previously been reported. A 38-year-old man with obstructive jaundice, who was originally thought to have cholangiocarcinoma associated with opisthorchiasis (a common combination in thailand), was finally proved to have tuberculosis of the common bile duct with adjacent tuberculous lymphadenitis. Following T-tube drainage and antitubercular therapy, he made a complete recovery. The importance of a tissue diagnosis in all cases of obstructive jaundice is emphasized to avoid missing rare but curable diseases. ( info) |
147/291. Massive tuberculous mesenteric lymphadenopathy. Abdominal tuberculosis accounts for 10% of all tuberculosis seen in papua new guinea. Nodal tuberculosis is usually associated with intestinal or peritoneal lesions. A case of massive tuberculous mesenteric lymphadenopathy with recurrent intestinal obstruction is presented here with a review of the relevant literature. ( info) |
148/291. Multi-organ involvement of tuberculosis--case report of an atypical presentation. A case involving tuberculosis of multiple organs and mimicking carcinoma in several respects is presented. ( info) |
149/291. Abdominal tuberculosis in children: CT findings. Tuberculous peritonitis is a rare manifestation of childhood tuberculosis. The computed tomographic (CT) scans of three patients with abdominal tuberculosis were reviewed to determine the range of abdominal involvement. This report describes the following CT features of abdominal tuberculosis: (1) diffuse lymphadenopathy involving mesenteric and retroperitoneal lymph nodes; (2) low-density lymph nodes with multilocular appearance following intravenous contrast; (3) high-density ascites; (4) mottled low-density masses in the omentum; (5) thickening of the bowel wall adjacent to the mesentery; and (6) hepatic pseudotumors. These CT features of abdominal tuberculosis, in the appropriate clinical setting, should help optimize the correct diagnosis and management of tuberculosis in children. ( info) |
150/291. diagnosis of a carotid body chemodectoma with dynamic radionuclide perfusion scanning. The first case of a carotid body chemodectoma that was diagnosed using dynamic radionuclide perfusion angiography and subsequently excised is presented. The value of this technic in the investigation of pulsatile tumors is emphasized. ( info) |