| A 17-year-old Filipina with a three-year history of intermittent, projectile vomiting and weight loss was admitted. A diagnosis of peptic ulcer disease was made, but she was unresponsive to antiulcer therapy. fever, anorexia, cough, and exposure to tuberculosis were denied. Chest x-ray was normal. On barium swallow, the stomach and duodenal bulb were dilated. Endoscopic antral biopsy showed chronic inflammation. Computed tomography revealed enlarged periportal and peripancreatic lymph nodes and an intrahepatic mass. Liver biopsy failed to show any acid-fast bacilli. On laparotomy, the pyloroduodenal area was extrinsically compressed by surrounding lymph nodes, which, on biopsy, contained granulomatous inflammation with caseation necrosis and Langhan's giant cells. Gastrojejunostomy was done and antituberculous drugs were given. pyloric stenosis due to tuberculosis is rare, but it should be considered in patients who come from areas where the disease is endemic. Medical management for such cases may suffice. ( info) |
222/291. Bilateral inguinal scrofuloderma during steroid therapy in a patient with bullous pemphigoid. This report described a case of scrofuloderma that developed in the bilateral inguinal regions during treatment of bullous pemphigoid with systemic corticosteroid. Analysis of the literature on scrofuloderma between 1978-1993 disclosed that the number of cases with extracervical involvement are increasing. immunosuppression could disseminate tuberculous focuses, resulting in extracervical involvement of SD connected with the underlying extrapulmonary tuberculous lesions. ( info) |
223/291. Nodular skin tuberculosis with lymphatic spread--a case report. An unusual case of tuberculosis paronychia with skin infection of the big toe was recently seen in a patient returning from Kalimantan. This was complicated by inguinal lymphadenitis and tuberculosis abscess formation. The diagnosis was made on culture of the pus from the abscess and upon biopsy and histological examination of the skin lesion from the toe. The patient responded to surgical treatment and chemotherapy with ethambutol, rifampicin and isoniazid. ( info) |
224/291. Atypical mycobacterial cervical lymphadenitis associated with Sweet's syndrome. We report the case of a 52-year-old woman with a non-tuberculous (atypical) mycobacterial cervical lymphadenitis, caused by mycobacterium fortuitum, in association with Sweet's syndrome. The cervical lymphadenitis was resistant to medical treatment, and the Sweet's syndrome occurred intermittently. Systemic steroid treatment was required to control the cutaneous symptoms. ( info) |
| A 32-year old Thai woman, gravida 1, para 1, had low risk gestational trophoblastic disease. Evacuation and chemotherapy was given (January 1990). She presented two years later (June 1992) with bilateral cervical lymphadenopathy. Cervical tuberculous lymphadenitis was confirmed by biopsy and Ziehl-Neelsen method. There were no clinical symptoms of tuberculosis. Antituberculous drugs, 2HRZ/4HR (H = isoniazid, R = rifampicin, Z = pyrazinamide) were given and no relapse of either choriocarcinoma or tuberculous lymphadenitis mimicking other pathologic processes and clinical suspicion is warranted. ( info) |
226/291. Necrotizing granulomatous cervical lymphadenitis associated with B lymphocyte abnormalities and a positive PPD reaction. sarcoidosis is a diagnosis often made by exclusion. We present a case of what we believe is sarcoidosis presenting as cervical lymphadenopathy. Complicating issues in this patient included B lymphocyte abnormalities, and a positive PPD reaction. The patient continues to be steroid dependent. This case illustrates the difficulties in diagnosis and management of sarcoidosis. ( info) |
227/291. Anti-tuberculous therapy and acute liver failure. The incidence of tuberculosis has been increasing since 1987, exposing a greater number of patients to the risks of three potentially hepatotoxic drugs, isoniazid, rifampicin, and pyrazinamide. awareness of potentially severe drug hepatotoxic reactions is vital because fulminant hepatic failure is a devastating and often fatal condition without liver transplantation. We report four cases of fulminant hepatic failure caused by rifampicin, isoniazid, or both. These cases highlight the need for stricter adherence to and review of current guidelines on liver function tests after starting anti-tuberculous therapies. ( info) |
228/291. 111In-octreotide uptake in granulomatous and tumor lesions in a patient with small-cell lung cancer. A case of a patient with small cell lung cancer and right submandibular node enlargement due to granulomatous lymphadenitis is presented. Diagnostic procedures included: biopsy of the cervical node, transmission computed tomography of the chest, bronchoscopic examination and biopsy of the pulmonary lesion. The patient underwent 111In-octreotide scintigraphy (whole body and single photon emission tomography) which revealed both lesions. We conclude that granulomatous lesions are to be considered as a possible cause of false positive results, when octreotide scintigraphy is used to evaluate distant metastases in patients with known cancer. ( info) |
229/291. Isolated peripheral tuberculous lymphadenitis in adults: current clinical and diagnostic issues. Eight cases of isolated peripheral tuberculous lymphadenitis occurred over a 16-month period at our institution, prompting a literature review to establish the epidemiology, clinical manifestations, and current approaches to diagnosis and treatment of this disorder. It occurs most commonly in young adult women who either are immigrants from areas where tuberculous is endemic or have histories of travel that are suggestive of exposure to mycobacterium tuberculosis. The disease is indolent and usually presents as a unilateral painless neck mass. Constitutional symptoms are rare, except in individuals infected with the human immunodeficiency virus (hiv). The results of skin testing with purified protein derivative are invariably positive. Excisional biopsy for histopathologic and microbiological evaluations provides the highest diagnostic yield, although fine needle aspiration may be useful for hiv-infected individuals and in areas of the world with a high prevalence of disease. A 6-month course of combination antituberculous therapy is adequate for disease due to susceptible organisms. This infection may be readily diagnosed if suggestive epidemiological and clinical findings lead to expeditious tissue sampling. ( info) |
230/291. Transient exacerbation of tuberculous lymphadenitis during chemotherapy in patients with AIDS. We describe three men with disseminated, drug-sensitive tuberculosis and advanced human immunodeficiency virus disease (CD4 lymphocyte count, < 50/mm3) who had flares of tuberculous lymphadenitis with suppuration during the initial weeks of successful chemotherapy. Bactericidal drugs may kindle these transient exacerbations, which involve neutrophils but apparently do not require normal helper T cell function. In patients with AIDS, as in immunocompetent individuals, treatment-related flares of lymphadenitis are usually not an adverse sign, provided that drug resistance and nonadherence have been excluded. ( info) |