Tuberculosis of the esophagus

A case of tuberculosis of the esophagus is presented in a patient with pulmonary tuberculosis. The patient, complaining of dysphagia, had esophagoscopic examination which showed a submucosal tumor with central ulceration. Tissue biopsy, under direct vision from the tumor mass, confirmed the diagnosis of tuberculosis. The patient has been asymptomatic under treatment. Both esophageal and pulmonary lesions are largely improved.     

Tuberculosis of the skull

Because tuberculosis of the skull is relatively unusual occurrence, it may not be immediately recognized. It responds readily to chemotherapy and should be suspected in disseminated tuberculosis or in any draining lesion of the skull that is sterile or fails to respond to conventional antibiotic therapy.     

Tuberculosis screening and compliance with return for skin test reading among active drug users

OBJECTIVES: This study assessed the independent and combined effects of different levels of monetary incentives and a theory-based educational intervention on return for tuberculosis (TB) skin test reading in a sample of active injection drug and crack cocaine users. Prevalence of TB infection in this sample was also determined. METHODS: Active or recent drug users (n = 1004), recruited via street outreach techniques, were skin tested for TB. They were randomly assigned to 1 of 2 levels of monetary incentive ($5 and $10) provided at return for skin test reading, alone or in combination with a brief motivational education session. RESULTS: More than 90% of those who received $10 returned for skin test reading, in comparison with 85% of those who received $5 and 33% of those who received no monetary incentive. The education session had no impact on return for skin test reading. The prevalence of a positive tuberculin test was 18.3%. CONCLUSIONS: Monetary incentives dramatically increase the return rate for TB skin test reading among drug users who are at high risk of TB infection.     

Tuberculosis of the breast

Tuberculosis of the breast is a rare modern disease or a forgotten diagnosis. During the last 15 years (1982-1996), 28 cases of mammary tuberculosis were reported in Japan. The initial diagnosis of almost all were carcinoma. Physical sign, mammography and USG are not so usefull for the diagnosis. It is important for the early and certain diagnosis to detect acid-fast bacilli on smear or culture and to perform pathological examination on biopsied specimen.     

Tuberculosis of the pleura

BACKGROUND: Tuberculosis is a leading cause of mortality worldwide, with a growing death rate. Pleuritis remains the most common extrapulmonary site of involvement. Epidemiologic trends have altered the presentation of disease. The advent of molecular biology has allowed new insights into disease mechanisms. In this paper, I review the salient features of pleural tuberculosis, highlighting recent epidemiologic trends and advances in diagnosis. METHODS: Literature concerning pleural tuberculosis was identified by a MEDLINE search; additional sources were identified by review of the bibliographies from these papers. RESULTS: Tuberculous pleuritis is uncommon in the United States and now more commonly reflects reactivation of old infections. Patients with coexistent tuberculosis and HIV infection have a higher rate of pleural reaction than non-HIV-infected persons. CONCLUSIONS: Closed pleural biopsy remains the diagnostic procedure of choice; newer diagnostic methods do not have favorable operating characteristics in areas of low tuberculosis incidence. Recommended anti-tuberculous therapy is identical to active pulmonary disease; corticosteroids should not be routinely given.     

Tuberculosis of the breast

Twenty-one cases of mammary tuberculosis are reported and the attendant clinical and histological difficulties described. It is probable that contemporary clinicians would now make the clinical diagnosis of breast abscess or carcinoma. Furthermore, the histological features (without demonstration or culture of the organism) may be confused with those granulomatous epithelloid reactions seen in mammary duct ectasia (comedo cell mastitis, plasma cell mastitis) and in traumatic fat necrosis.     

Tuberculosis of the larynx

Laryngeal tuberculosis was diagnosed in two men, a 73-year-old man Dutch by birth and a 40-year-old one Turkish by birth. In the former patient it was probably primary tuberculosis, in the latter secondary (he had lung tuberculosis as well). The clinical picture was highly suggestive of laryngeal carcinoma in both patients. They both recovered with chemotherapy. Laryngeal tuberculosis may mimic laryngeal carcinoma. The diagnosis is based on Ziehl-Neelsen staining, culture and polymerase chain reaction (PCR) on Mycobacterium tuberculosis. Because laryngeal tuberculosis is highly infectious, the patient has to be nursed in isolation and people in his or her environment have to be screened. The response of laryngeal tuberculosis to chemotherapy is good.     

Tuberculosis of the tarsal conjunctiva

A woman sixty-five old presents one pronounced swelling of the eyelids at the both eyes with the appearance of the multiple chalasions. The patient at twenty-six years old presented pulmonary tuberculosis, in the present stabilized. The morphopathology exam by a fragment of tarsus and conjunctiva shows an lymphocyt inflammatory infiltration with the presence of the epithelial cells and caseation areas. At level of conjunctiva it constats the presence of tuberculum follicles that are present too at the level of Meibomius canals of excretions. The disease is considered like an allergical reaction at endotoxin of Koch bacillus, secondary by some old tubercular lesions.     

Tuberculosis of the parotid gland

The presentation of tuberculosis as an isolated parotid lump is rare. In this paper, six cases with tuberculous parotitis are reported which were evaluated as a benign parotid neoplasm in 216 specimens pre-operatively. All but one of them had no previous history of tuberculosis and all had a parotid lump as a sole symptom for at least one year. The diagnosis of tuberculosis was made, after superficial parotidectomy, by histopathology. Parenchymal involvement and intraparotid lymph node involvement with tuberculosis were seen in five and three patients, respectively. Two of the patients had lymph node involvement outside the parotid area. One of six patients had a coincidental Warthin tumour. A surgical approach is not only therapeutic but also diagnostic when other diagnostic tools fail.     

Tuberculosis of the endocrine system

Tuberculosis now rarely affects the endocrine system. Adrenal tuberculosis is responsible for Addison's disease, but now fewer cases are affected. Although the symptoms and signs of Addison's disease appear when most of the adrenal glands have been functionally destroyed, adrenal tuberculosis results in not only chronic adrenal insufficiency but also acute adrenal failure. Dissemination of M. tuberculosis is responsible for adrenal tuberculosis, other tuberculous lesions (including the past lesions) should be evaluated. Bilateral adrenal calcification and/or enlargement which are often pointed out on abdominal CT, are important signs of adrenal tuberculosis. Thyroid gland is rarely affected, but thyroid function impairment is uncommon even if it is affected. Hypopituitarism due to intracranial tuberculoma or tuberculous meningitis are also reported. Tuberculosis of the endocrine system is a part of disseminated infection, so it should not be overlooked in miliary spread tuberculosis.     

Tuberculosis of the sacroiliac joint

A 23-year-old woman presented with low back pain of several months' duration. A tuberculous infection of the left sacroiliac joint was diagnosed by closed-needle biopsy. The clinical presentation, radiological features and outcome of this patient are discussed.     

Tuberculosis of the hip in children

We have reviewed 74 tuberculous hips in 73 children treated from 1950 to 1991. From 1979 to 1991 we treated 28 patients with rifampicin, isoniazid and pyrazinamide given for nine months (series A), using active mobilisation for the more recent cases. Before this, 46 hips had been treated with streptomycin and isoniazid with or without para-aminosalicyclic acid given for a mean of 18 months (series B), and all these patients were immobilised for a mean of 2.2 years. The radiological appearances at presentation as classified by Shanmugasundaram (1983) predicted the outcome. Most hips were of the 'normal' type (50% and 59% of series A and B respectively) followed by the dislocating type (25% and 13%) and the atrophic type (8% and 9%). There were good or excellent results in 93% of the 'normal' type. All the atrophic type had poor results. The dislocating type had a poor result if the joint space was narrow after reduction of the hip. Early mobilisation had no effect on the outcome of the 'normal' type of disease. The newer drug regimens allowed for shorter courses of treatment, but did not necessarily give a better outcome.     

Tuberculosis in the elderly patient

Melkersson-Rosenthal syndrome is a rare form of hereditary angioedema characterised by a triad of symptoms of which incomplete (oligo- or monosymptomatic) forms have been described, frequently associated with dysreactive diseases or neoplasia. The authors describe the case of a 48-year-old man with an incomplete form which was successfully treated with steroids and, after a careful and detailed revision of the literature on the subject, they make a number of etiopathogenetic, histopathological, clinical and therapeutic comments.