1/11. Visceral leishmaniasis masquerading as tuberculosis in a patient with AIDS.We report a case of visceral leishmaniasis presenting as significant lymphadenopathy in a patient with acquired immune deficiency syndrome. The lymphadenopathy was initially suspected to be tubercular in nature on pathological examination. This report highlights the increasing incidence of acquired immune deficiency syndrome and Leishmania co-infection in india, and the importance of demonstrating tubercle bacilli on culture before suggesting a diagnosis of tuberculosis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/11. Renal amyloidosis following tuberculosis.amyloidosis, either primary or secondary, may be defined as a group of chronic infiltrative disorders that have in common a beta-pleated sheet configuration on x-ray diffraction examination, a fine fibrillar nonbranching appearance on electron microscopy and an apple-green birefringence when examined under polarised light after staining with congo-red. Renal amyloidosis is a rare entity in the pediatric age group and is almost always secondary in nature, related to chronic infections and inflammatory conditions. It occurs 2-7 years after a chronic inflammatory process; however an onset as early as 9 months of life is known. The diagnosis of amyloidosis is suspected on the basis of clinical features and is established by obtaining an appropriate tissue biopsy and demonstrating amyloid with appropriate stains. All the tissues obtained must be stained with congo-red stain which is the singlemost useful diagnostic test to define amyloidosis. In order to differentiate the primary from secondary variety, the deposits may be treated with potassium permanganate before congo-red staining. In secondary amyloidosis, the green birefringence seen under polarized light is abolished. Therapeutic approaches include specific measures to reduce the amyloid deposition and general measures to relieve symptoms related to involvement of specific organs. The prognosis in renal amyloidosis is relatively poor, with a median survival of 9-13 months in primary amyloidosis complicated by renal involvement, and more than 50 months in secondary amyloidosis. We have reported a case of secondary amyloidosis following tuberculosis and have discussed the clinical features, diagnosis and management of amyloidosis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/11. Tuberculosis as a cause of recurrent fever of unknown origin.Recurrent fever constitutes a diagnostic challenge for clinicians, due mainly to the intermittent nature of the fever that results in incomplete investigations. We describe three patients with recurrent fever thought to be due to tuberculosis, and review the 14 previously reported cases who fulfil the criteria of recurrent fever for at least 1 month's duration. The median duration of symptoms before diagnosis was 5 months, and the duration of the febrile bouts ranged from a few hours to 1 week. The most common complaints were constitutional symptoms and abdominal pain, and most patients had significant underlying conditions. The mortality rate was 31%, and was limited to the earlier cases. Routine laboratory studies are not very helpful for the diagnosis of this condition, and chest radiographs showed some alteration in half the cases at the time of diagnosis, although in some cases represented old, healed lesions. PPD testing was positive in most cases, particularly in those without underlying conditions. Empirical antituberculous therapy should be considered in cases of recurrent fever, especially in areas of high prevalence or in patients with predisposing conditions.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/11. Unilateral bronchiectasis and esophageal dysmotility in congenital adult tracheoesophageal fistula.Tracheoesophageal fistulas (TEF) in adults are most commonly neoplastic, and very rarely congenital in nature. We report a 45-year-old Hispanic male with TEF and initial presentation of minimal hemoptysis. The patient had radiographic evidence of unilateral upper lobe (RUL) bronchiectasis, massive esophageal dilatation, and dysmotility. However, there was no evidence of esophageal malignancy, achalasia, or Chagas' disease. bronchoscopy revealed a large TEF in the posterior wall of trachea, which was not visualized on esophagram or esophagoscopy. bronchoalveolar lavage (BAL) cultures grew mycobacterium avium complex (MAC). Our report illustrates that idiopathic, or congenital, TEF can be associated with esophageal dysmotility, adulthood bronchiectasis, and atypical mycobacterial superinfection.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/11. Ocular ethambutol toxicity.ethambutol is an antimicrobial agent used frequently to treat tuberculosis. The most commonly recognized toxic effect of ethambutol is optic neuropathy, which generally is considered uncommon and reversible in medical literature. We describe a 43-year-old man who developed signs and symptoms of bilateral optic neuropathy during treatment with ethambutol. This case and a review of the literature show the severe and unpredictable nature of ethambutol toxicity and its potential for irreversible vision loss despite careful ophthalmologic monitoring.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/11. parotid gland tuberculosis--a case report.Isolated parotid gland tuberculosis in the clinical absence of tuberculosis elsewhere in the body, is a rare clinical entity. It is often misdiagnosed as parotid gland tumour in the absence of symptoms suggestive of tuberculosis. We are presenting this case to highlight the unusual solitary nature of the lesion, the absence of any other tuberculous focus in the body, the inconclusive findings of the pre-operative investigations like fine needle aspiration cytology (FNAC), and computed tomography (CT), and the need for histopathology for definitive diagnosis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/11. Successful unrelated mismatched cord blood transplantation in an infant with severe combined immunodeficiency and mycobacterium bovis bacillus Calmette-Guerin disease.The case reported here of an infant who presented with pneumocystis carinii pneumonia, CD4 lymphopenia, and hypogammaglobulinemia attributable to severe combined immunodeficiency (SCID). This report discussed treatment of mycobacterium bovis bacillus Calmette-Guerin disease with unrelated cord blood transplantation in addition to antituberculous therapy, by adoptively transferring donor immunity with induction of mixed chimerism. Because of the unique nature of umbilical cord blood hematopoietic cells, engraftment without conditioning may be possible in SCID patients without fully matched donors.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/11. Colonic malacoplakia and abdominal tuberculosis in a child. Report of a case with review of the literature.A 4 1/2-year-old girl had colonic malacoplakia of two years' duration, the presenting symptom being rectal bleeding. Abdominal tuberculosis and escherichia coli lumbar abscess were diagnosed at the age of 3 1/2 years. Despite antituberculous treatment, there was no improvement and she died from protein-losing enteropathy. The patient is discussed and the literature reviewed, with special emphasis on the incidence of malacoplakia in children, the aggressive nature of colonic malacoplakia, and the lack of response to treatment. A brief review of the pathogenesis of malacoplakia is considered.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/11. cellulitis versus positive purified protein derivative? A case report and review of the literature.The tuberculin skin test is one of the most widely used diagnostic aids ever developed and remains the only technique of detecting mycobacterium tuberculosis infection other than actually culturing the organism. False-positives are an acknowledged problem, especially among health care workers (HCW), in whom rescreening can raise more questions than answers. A HCW presented with a severe response to an annual screening test and was retested 6 weeks later with normal results (non-reactive). Causes of false-positives (not including cross-reactivity) are discussed. Readers of the purified protein derivative reaction need to consider alternative explanations for a significant response than infection with tuberculosis, given the medical history and nature of response.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/11. Coexistence of Kaposi's sarcoma and tuberculosis in a renal transplant recipient.BACKGROUND: We describe a case of Kaposi's sarcoma that developed in a renal transplant recipient as early as 5 months after the transplant. METHOD: The Kaposi's sarcoma evolved in an aggressive manner, involving the oral mucosa, the cervical and mediastinal lymph nodes, the gastrointestinal tract, and possibly the lung. Histological features of tuberculosis were also detected incidentally on an excisional biopsy of the lymph node. The patient was given 12 months of antituberculous chemotherapy. At the same time, immunosuppression was gradually tapered over a 2- to 3-week period. RESULTS: Despite the aggressive nature of the disease, the Kaposi's sarcoma regressed completely without the institution of chemotherapy. The patient remained disease-free after a follow-up period of 30 months. The kidney allograft, however, was rejected and the patient required dialysis again. CONCLUSION: Although lymphadenopathy is a well-recognized feature in organ transplant recipients who develop Kaposi's sarcoma, one has to watch out for other coexisting diseases, such as tuberculosis, lymphoma, and cytomegalovirus infection.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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