Tubercular Empyema Thoracic: An Acute Presentation with COVID-19 Co-infection

COVID-19 (Coronavirus Disease 2019) pandemic is caused by a novel Coronavirus, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2, which has received worldwide attention and most COVID-19 patients have respiratory symptoms and develop a mild disease. In addition, co-infection of SARS-CoV-2 with other respiratory infections of bacterial, other viral and fungal origin needs to be validated. The clinical features, course and treatment of TB patients with COVID-19 are unclear and understudied. There is paucity of literature on this co-infection. Here, authors present a case report of a young diabetic Asian male patient who presented to the emergency department as COVID-19 positive with acute exacerbation of symptoms, who later developed respiratory distress and was eventually found to have a lung abscess with subsequent tubercular empyema thoracic on contrary to a severe COVID-19 pneumonia or a fungal infection, as thought of. Contrast Enhanced Computed Tomography (CECT) chest along with Cartridge-Based Nuclei Acid Amplification Test (CBNAAT) of pleural fluid pus confirmed the tubercular lesion timely to aid the diagnosis and further course of management.

Tubercular Lesions in Brain Parenchyma

Background: Preoperative neuro-radiological features of tuberculosis involving brain lesions may mimic neoplastic lesions of brain & skull base and post operative histopathological study or response to empirical anti-tubercular therapy brings the ultimate diagnosis. Objective: Here we present our experience of 76 cases of cerebral and cerebellar tuberculosis that was managed surgically with anti-tubercular drugs or medical treatment alone without histopathological confirmation. Methodology: All cases of brain parenchymal tuberculosis confirmed histopathologically after surgery or confirmed by succesfull conservative treatment with anti-TB from January 2008 to June 2015 were included for study. Tubercular meningitis was excluded from the study. Patients underwent some form of surgery that confirmed the tuberculosis by histopathologically. Patients with suspected tubercular lesion in brain were treated empirically with antiTB. Post operative imaging was done with CT scan of brain or MRI of brain in immediate post operative period, six months after operation and 18 months after operation. Results: 34 patients underwent surgery to confirm the tuberculosis and 44 patients with suspected tubercular lesion in brain were treated empirically with antiTB of which 40 patients responded successfully and rest 4 patients did not responded and underwent surgical excisional biopsy. Common clinical features include features of raised ICP with focal signs and symptoms. Concurrent other systemic tuberculosis was found in three cases. One patient had history of full course anti-tubercular therapy for pulmonary tuberculosis 20 years back. Conclusion: In suspected TB lesions, conservative treatment without histopathological diagnosis may be adopted with ultimate same result Bangladesh Journal of Infectious Diseases, December 2018;5(2):45-60

Isolated Intraspinal Extradural Tubercular Lesion without Osseous Involvement

Tuberculosis (TB) continues to be a major public health problem in developing countries. Approximately 10% of patients with extrapulmonary TB have skeletal involvement. The spine is the most commonly affected skeletal site. The neurologic manifestations of spinal TB are most often secondary to bone involvement but can also be due to neural and perineural tissues involvement. TB may involve any level from the cervical to lumbosacral region. Extradural tubercular granuloma without vertebral involvement is uncommon. The authors reported an uncommon case of isolated intraspinal extradural TB lesion without osseous involvement of the thoracic spine in an adult man. Surgical intervention along with chemotherapy is one of the preferred treatments for intraspinal extradural tubercular lesion.

Tubercular Dacryocystitis: A Quirky Diagnosis!!

ABSTRACT Tuberculosis of the lacrimal sac is a rare condition even in a place considered endemic to tuberculosis. It is usually suspected with either local or systemically present tubercular lesion or with a history of recurring failure of lacrimal drainage procedures. Failure to identify the ailment may have devastating consequences. We present a case of tubercular dacryocystitis and discuss its clinical spectrum. How to cite this article Gupta D, Gulati A. Tubercular Dacryocystitis: A Quirky Diagnosis!! Int J Otorhinolaryngol Clin 2016;8(2):65-67.

Preoperative malignant looking retrobulbar, infratemporal and middle cranial fossa tuberculoma in a young child - a case report

Tuberculosis involving skull base and brain is relatively common in developing countries. Preoperative neuro-radiological features of such lesions mimic neoplastic lesions of brain & skull base and postoperative histopathological study brings the ultimate diagnosis. Here we present a case of large tubercular lesion involving retrobulbar, infratemporal and middle cranial fossa that preoperatively thought to be a malignant lesion in a young child and was managed surgically with anti-tubercular drugs having a happy termination. Even radiologically malignant looking mass lesion in brain and skull base can be proved as tuberculosis that can bring happiness to the patient and also to the treating neurosurgeons. DOI: http://dx.doi.org/10.3329/bjms.v13i3.7518 Bangladesh Journal of Medical Science Vol.13(3) 2014 p.323-325

Unusual presentation of breast lump-diagnosed on FNAC as tubercular lesion

Tuberculosis of breast is a rare disease even in endemic areas accounting for 0.1%- 0.5% of all infections. Multiparous young females are commonly affected particularly during pregnancy and lactation. In the present study, we are reporting a case of tuberculosis of breast with ipsilateral axillary involvement in a multiparous young non lactating female. Diagnosis was confirmed after cytological evaluation. Clinical or radiological distinction of mammary tuberculosis from breast carcinoma or abscess is often difficult to achieve. Cytology is an effective method for confirmation of these uncommon disorder an also can reduce unnecessary surgery which should be restricted for complicated cases. Nepal Journal of Medical Sciences | Volume 02 | Number 02 | July-December 2013 | Page 187-189 DOI: http://dx.doi.org/10.3126/njms.v2i2.8974

Genital Tuberculosis – An Uncommon Presentation

A married women of 30 years, mother of one child, housewife was referred to out patient department of Khulna Medical College Hospital with history of blood stained vaginal discharge, secondary amenorrhoea for 3 years and evening rise of temperature and anorexia for 3 months. On speculum examination, cervix was oedematous, bright red in colour with papillary growth which bleeds on touch. She also had bilateral excavated lesion at the lowest part of the vagina close to the introitus which was red in colour with undermined edge. Visual inspection aided by acetic acid (VIA) was positive. Colposcopy guided biopsy was taken from unhealthy areas. There was extensive mottling on chest X-ary. She had high ESR, AFB+ve on sputum culture. The patient was diagnosed as a case of active pulmonary TB. Histopathological report of cervical tissue showed granulomatous lesion. Patient was given a regimen of standard anti TB drugs. After 2 weeks, during her first follow up, patient had few symptoms with regression of cervical growth and disappearance of vaginal ulcer. Patient herself stated about her wellbeing after the start of anti- TB drugs. Though cervical TB is not uncommon among genital TB (5-24%), vaginal tubercular lesion is very uncommon and concurrent pulmonary, endometrial, cervical and vaginal tuberculosis is a rare event. Careful evaluation is needed to diagnose tubercular infection in genital organs specially in GOPDs and colposcopy clinics. DOI: http://dx.doi.org/10.3329/jbcps.v30i2.11421 J Bangladesh Coll Phys Surg 2012; 30: 108-111

Clinical Evaluation of Efficacy of99mTC -Ethambutol in Tubercular Lesion Imaging

Purpose. The aim of this work was to develop specific radiopharmaceutical and to evaluate its efficacy in human to detect and locate the tubercular lesion.Materials and Methods.99mTc-Ethambutol (EMB) was produced by direct labeling method.In vitro and in vivobiological studies and animal experiments were done. Phase I Clinical trial was performed. As per plan, 2 normal human subjects for biodistribution studies and fourteen patients (8 males and 6 females; age range of 25–50, with one patient aged 12 years as an exception) were chosen for clinical trial. Whole body scan and spots were acquired at 1 hour and 4 hour. Angiography, blood pool, and 24-hours spot images of the infected areas were also acquired.Result. Radiolabeling yielded>85%of labeled complex.In vitro and in vivobiological studies and animal experiments indicated99mTc-EMB as a specific tuberculosis imaging agent. The biodistribution study in normal human subjects suggested stability of99mTc-EMB, with main excretory pathways being renal and hepatobiliary, which appeared to be similar to the known behavior of unlabeled EMB. No adverse reactions were observed.99mTc-EMB got localized in pulmonary and bone tubercular lesions. Scintigrams of99mTc-EMB and99mTc-Ciprofloxacin were compared at different time intervals.Conclusion. The present study states that developed99mTc-EMB has high potential to qualify as a specific tuberculosis imaging radiopharmaceutical and is safe for human use.