1/11. Primary mycobacterial infection of the uvula.Tuberculosis, and non-tuberculous mycobacterial infections are becoming more common thus it is more likely that otolaryngologists will encounter these conditions. We describe an otherwise well patient, with symptoms and signs from chronic uvular inflammation, who proved to have a primary mycobacterial infection. This is an unique presentation in the literature and reminds clinicians of the need, where uncertainty exists in diagnosis, to consider mycobacterial infections.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
2/11. Primary tuberculosis of tongue.A case of a 55 years old lady with tuberculosis of the tongue is reported. Patient presented with non-healing ulcer in dorsum of the tongue for one year. Initial biopsy and histopathological examination revealed non-specific inflammation. After surgery, biopsy report proved primary tuberculosis of tongue. Anti-tubercular therapy for nine months showed uneventful recovery of the patient.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
3/11. Nasopharyngeal granulomatous inflammation and tuberculosis complicating undifferentiated carcinoma.OBJECTIVE: Four cases of nasopharyngeal granulomatous inflammation after radiotherapy for undifferentiated carcinoma were analyzed for tuberculosis, and the histologic features were compared. STUDY DESIGN AND SETTING: We conducted a retrospective study with analysis of tuberculosis by Ziehl Neelsen staining and polymerase chain reaction analysis for mycobacterium tuberculosis dna on histologic materials. RESULTS: Three patients had previous nasopharyngeal undifferentiated carcinoma, one had previous metastatic undifferentiated carcinoma to cervical lymph nodes, and all patients received similar radiotherapy regimen. The light microscopic features were similar with epithelioid histiocytes and granulomas with Langhan's giant cells. In 3 cases, acid-fast bacilli were identified by Ziehl Neelsen stain, and 1 was negative. The results of 2 cases were confirmed by polymerase chain reaction analysis for Myocbacterium tuberculosis dna. CONCLUSION: Granulomatous reaction after radiotherapy of nasopharyngeal undifferentiated carcinoma can be caused by tuberculosis. SIGNIFICANCE: Diligent search for organisms in postirradiation granulomatous inflammation is warranted to avoid missing an occult tuberculosis infection.- - - - - - - - - - ranking = 6keywords = inflammation (Clic here for more details about this article) |
4/11. The cytology of pediatric masses: a differential diagnostic approach.In the united states, fine-needle aspiration biopsy (FNAB) and other cytodiagnostic methods have been underutilized in the evaluation of masses in the pediatric age group. Cytopathologists and cytotechnologists are therefore relatively unfamiliar with the cellular features of lesions that occur in children. On the basis of the cytologic findings from 64 pediatric cases, including 56 FNABs and 8 intra-operative imprints, a differential diagnostic approach to lesions in this age group is presented. The majority of cases can be placed into 1 of 5 cytomorphologic categories: (1) round-cell pattern, (2) mixed inflammatory pattern, (3) spindle-cell pattern, (4) epithelial pattern, and (5) cystic pattern. Once a cytomorphologic category is determined, evaluation for unique cellular features, special studies, and clinical correlation allows a specific diagnosis to be made in most cases. Pitfalls in pediatric cytopathology are illustrated by discussion of the following cases: a renal Burkitt's lymphoma mimicking a Wilms' tumor, a traumatic neuroma masquerading as a recurrent malignant schwannoma, Langerhans-cell histiocytosis resembling granulomatous inflammation, and a cystic granuloma that mimicked a branchial cleft cyst. Consideration of these problems and use of the recommended diagnostic approach will aid in interpretation in this difficult area.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
5/11. Lingual ulcer as the only sign of recurrent mycobacterial infection in an hiv/AIDS-infected patient.The report describes an hiv/AIDS patient seen at a referral center in mexico City, in whom a mycobacterial infection in the oral mucosa, probably tuberculosis (TB) was identified. The purpose is to describe the clinical and histological findings in an hiv-infected patient, who after being treated successfully for tuberculous lymphangitis 4 years ago, presented with a lingual ulcer as the only suggestive sign of recurrence of mycobacterial infection, probably M. tuberculosis. A 39-year-old man seen in the hiv clinic of the Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran" in mexico City since 1991 for hiv infection. In 1999 the patient developed tuberculous lymphangitis; he was managed with a 4-drug regimen for 12 months, with improvement of local and systemic symptoms. In May of 2003, the patient presented a painful superficial lingual ulcer, 0.7 cm in diameter, well circumscribed, crateriform with slightly elevated, irregular and indurated borders, of 4 months duration. The histopathological examination showed chronic granulomatous inflammation with giant multinucleated cells, suggestive of mycobacterial infection, and recurrence of TB was considered. rifampin, isoniazide, pyrazinamide, ethambutol and streptomycin were administered. The lingual lesion improved with partial healing at the first week and total remission at 45 days after the beginning of the antituberculous treatment. In June, 2003, the patient began highly active antiretroviral therapy (HAART) that included two NRTIs and one NNRTI. At 7 months of follow-up, the patient remains free of lingual lesions. The particularity of the present case is that the lingual ulcer was the only sign of infection by mycobacteria, suggestive of TB, in an hiv/AIDS patient that probably represented a recurrence of a previous episode.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
6/11. Tuberculous otitis media: report of 2 cases on Long Island, N.Y., and a review of all cases reported in the united states from 1990 through 2003.We report 2 cases of tuberculous otitis media that were diagnosed at Stony Brook University Hospital in new york since 1999. Both patients were women, aged 30 and 31 years. One patient had grown up in russia, the other was a native-born American who had never left the East Coast region of the united states. Both patients had been symptomaticfor many months; one complainedof chronic otorrhea, and the other reported otorrhea, hearing loss, and discomfort. Neither patient responded to medical management, and both ultimately underwent surgery. One was diagnosed after surgical pathology revealed acid-fast bacilli on frozen-section analysis. In the other, pathology revealed chronic inflammation and granulomata, butstains were negative and her diagnosis was delayed for almost 2 years. We also review 9 other cases of tuberculous otitis media in the united states that have been reported in the literature since 1990. Our review suggests that the number of cases is rising in areas where tuberculosis is most common--that is, in major U.S. cities. Although 3 of these 9 cases occurred as reactivation disease in immigrants, most might have occurred as a result of local transmission. Clinicians should maintain a high degree of suspicion for tuberculosis in patients with chronic otitis symptoms, particularly those who are at higher risk of exposure to tuberculosis.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
7/11. hiv/TB co-infection: literature review and report of multiple tuberculosis oral ulcers.Human immunodeficiency virus/tuberculosis (hiv/TB) co-infected subjects demonstrate enhanced hiv replication and plasma viremia; CD4 T-cell depletion; morbidity and mortality; and susceptibility to secondary bacterial and fungal infections compared to subjects solely infected with hiv. As the incidence of hiv/TB infection has been increasing, one would have expected to encounter oral lesions of tuberculosis more frequently. However, such oral lesions are uncommon. The lesions usually occur as ulcerations of the tongue. We report an additional case in an hiv/TB co-infected 39 year-old black male, who presented with chronic, painless, multiple oral ulcers, occurring simultaneously on the tongue, bilaterally on the palate and mucosa of the alveolar ridge. Microscopic examination confirmed the presence of chronic necrotizing granulomatous inflammation, with the identification of acid fast bacilli in the affected oral mucosal tissue. Anti-retroviral and anti-tuberculous treatment resulted in the resolution of the oral lesions. Confirmatory histopathological diagnosis following a biopsy is essential to determine the exact nature of chronic oral ulceration in an hiv individual and especially to distinguish between oral squamous cell carcimoma, lymphoma, infection (bacterial or fungal) and non-specific or aphthous type ulceration.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
8/11. Oral tuberculosis associated with a treatment with anti-rheumatic drugs.BACKGROUND: The use of immunosuppressive medication is a dominant risk factor for infection in patients with rheumatoid arthritis (RA). methotrexate (MTX) is one of the traditional disease-modifying antirheumatic drugs. Adalimumab [a human anti-tumor necrosis factor-alpha (anti-TNF-alpha) monoclonal antibody] represent an important advance in the treatment of RA and has been recently come in use. TNF-alpha plays a role in the host defense against mycobacterium tuberculosis and notably in granuloma formation. Infections occur at a high rate among those who use one or the combination of the two medications. METHOD: We examined a female patient that was referred to our department for evaluation and treatment of a granular lesion on the soft palate and uvula, complaining of mild dysphagia. The patient was treated for 4 months with MTX and adalimumab for RA before the oral lesion appeared. RESULTS: The histopathological examination of a specimen of the oral lesion, taken by biopsy, showed a chronic inflammation characterized by tuberculous granulomas. polymerase chain reaction test and culture of a new specimen was positive for M. tuberculosis. CONCLUSIONS: The therapeutic use of MTX or/and adalimumab for the treatment of RA or few others diseases, can cause oral tuberculosis.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
9/11. Primary tuberculosis of the oral cavity.Two cases of primary tuberculosis of the mouth are reported. Painless ulceration of long duration and enlargement of the regional lymph nodes that did not respond to conservative and antibiotic therapy were the main manifestations of the disease in both cases. In the first case the tubercle ulcer was located in the lower buccogingival sulcus of a 17-year-old girl. In the second case the lesion occurred as a chronic periodontal inflammation around the gingiva of the left lower second molar tooth. When the tooth was extracted, a painless ulceration appeared around the socket, which was filled by granulation tissue. Histopathologic examination; bacteriologic, serologic, and blood tests; and chest x-ray film confirmed the diagnosis. Predisposing factors that might favor primary inoculation of tubercle bacilli into oral mucosa are also discussed. Finally we emphasize that in such cases it is essential to attempt to locate a possible primary site elsewhere in the body before oral tuberculosis is considered the primary disease.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
10/11. Human lingual tuberculosis. An ultrastructural study.According to morphological criteria, the predominant cells from human oral tuberculosis granulomas are classified as monocytes, epithelioid cells, and multinucleated giant cells. The morphology of each cell type is related to its speculated function. It is theorized that macrophages and epithelioid cells represent an in vivo line of differentiation from undifferentiated monocytes and that giant cells form from a coalescence or syncytium of macrophages. The role of these phagocytic cells and other participating inflammatory cells in granulomatous inflammation is discussed.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
| | Next -> |