171/291. psoas abscess due to retroperitoneal tuberculous lymphadenopathy. A case of psoas abscess occurring during treatment of tuberculous lymphadenopathy is described. There was no evidence of a bony origin for this abscess. It appears likely that it arose from involved glands on the posterior abdominal wall. ( info) |
| The recent literature on abdominal tuberculosis is comprehensively reviewed, and seven cases of abdominal tuberculosis are reported, including four belonging to three generations of the same family. Possible explanations for this familial incidence are discussed. Abdominal tuberculosis is not so rare; 135 cases have recently been reported from the united states and canada. This review dissipates four common misconceptions: abdominal tuberculosis is rare, tuberculosis is a stigmata of the poor, abdominal tuberculosis is always associated with active pulmonary tuberculosis, and chronic abdominal pathology is synonymous with regional enteritis. Since the description of regional enteritis, more and more cases of chronic intestinal pathology have been labeled "regional enteritis." The fact that intestinal tuberculosis is rather uncommon should not automatically lead to the diagnosis of regional enteritis. The possibility that many cases of so-called regional enteritis may, in fact, be a stage or a variant of abdominal tuberculosis, is worth considering. Abdominal tuberculosis is not a relic of the past. It remains a real challenge to the diagnostic acumen and therapeutic skills of both the internist and the surgeon. ( info) |
173/291. The varied manifestations of abdominal tuberculosis. Eight cases of abdominal tuberculosis from the Department of medicine, singapore General Hospital are reported to illustrate the varied clinical manifestations of the disease. Presentation ranged from asymptomatic hepatomegaly to acute abdomen (intestinal obstruction/perforation). Chronic non-specific symptomatology (fever, weight loss, abdominal pain, diarrhoea, jaundice) was commonest. There were three patients with hepatic tuberculosis, two with tuberculous mesenteric lymphadenitis and three with intestinal tuberculosis, two of whom had concomitant tuberculous peritonitis. Only three patients had coexisting pulmonary tuberculosis. The diagnosis was unsuspected at presentation in four patients. Initial provisional diagnoses included typhoid, abdominal lymphoma, hepatic malignancy, chronic hepatitis and iatrogenic gut perforation. All patients responded totally to conventional antituberculous therapy. ( info) |
174/291. Cervical tuberculosis. Differential diagnosis and CT imaging. This paper shows some typical CT-scan patterns of tuberculous cervical adenitis. Two cases are presented which suggested to be a cyst of the first and second branchial cleft according to their appearance and location on CT-scan, but which turned out to be cervical tuberculous adenitis after further investigation. It is meant to stress the importance of tuberculosis in the differential diagnosis of cystic lesions of the neck on CT imaging. ( info) |
175/291. Hilar gland tuberculosis in Nepalese adults masquerading as malignant lymphoma. We report two Nepalese patients with tuberculosis, in whom the sole chest X-ray abnormality was hilar lymphadenopathy. This rare variant of tuberculosis, not previously described in Nepalese patients, may easily be mistaken for malignant lymphoma. ( info) |
176/291. Major adverse reactions to a short course of daily rifampicin. hypersensitivity, dyspnoea and shock reactions to rifampicin in a 24-year-old man are described after a short course of daily treatment for tuberculous lymphadenitis. These combined reactions have not previously been reported after such a short course of therapy. Treatment with fluids, steroids, and antihistamines for the dyspnoea and shock reaction, and withdrawal of rifampicin led to complete recovery. The increased use of rifampicin in short courses may lead to more such reactions being observed. ( info) |
| In a 1-year period 4 cases of disseminated tuberculosis were seen among homosexual men with hiv infection. In 3 of the cases tuberculosis was the initial manifestation of defective cell mediated immunity. It is concluded that tuberculosis must be considered in any anti-hiv positive patient presenting with fever of unknown origin. ( info) |
178/291. tuberculosis affecting the oesophagus. Three Asian patients presenting with dysphagia were shown to have oesophageal involvement secondary to adjacent tuberculous mediastinal lymph nodes. The findings included fistula between the oesophagus and the tracheobronchial tree and extrinsic compression of the oesophagus. These cases reflect the increasing incidence of mediastinal lymphadenopathy in adult tuberculosis, especially in our immigrant community. ( info) |
179/291. hypercalcemia and elevated 1,25(OH)2D3 levels in a dialysis patient with disseminated tuberculosis. A 37-year-old diabetic patient with end-stage renal disease on maintenance dialysis developed widely disseminated tuberculosis. tuberculosis was associated with hypercalcemia, inappropriately elevated serum levels of 1,25(OH)2D3, and consistently suppressed serum levels of iPTH. This case provides additional evidence that in granulomatous diseases extrarenal synthesis of 1,25(OH)2D3 may occur. ( info) |
| We have reported a case of diffuse hyperplasia of lymph nodes mimicking a malignant large cell lymphoma in a patient with active tuberculosis. The possibility of lymphoma coexisting with or superimposed upon the tuberculous infection proved untenable after a long follow-up. The potential of tuberculosis to produce florid lymphoid reactions should be taken into account when interpreting lymph node biopsies in similar clinical situations. ( info) |