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Disseminated tuberculosis in a non immun compromised patient with a complicated diagnosis.

Sahin H, Isık H, Uygun Ilıkhan S, Tanrıverdi H, Bilici M - Respir Med Case Rep (2014)

Bottom Line: The long time period between the exposure to TB bacillus and the onset of symptoms cause a delay in diagnosis.On the fourth month of the medical treatment the patient clinically recovered.Since the diagnosis of TB is difficult, high grade suspicion, combination of the radiologic, microbiologic and histopathological examinations are needed to achieve a diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Bülent Ecevit University School of Medicine, Department of Internal Medicine, Zonguldak, Turkey.

ABSTRACT
Tuberculosis (TB) has become a global emergency worldwide. The long time period between the exposure to TB bacillus and the onset of symptoms cause a delay in diagnosis. Herein, we report a case of 64-year-old female patient suffering from dyspepsia, anorexia, weight loss and abdominal pain for the last 8 months. Physical examination, ascites fluid evaluation, chest radiography, ultrasonographic and tomographic scans, histopathological analysis of the lymphadenopathy (LAP) and endometrial tissue revealed TB. A fourfold antituberculous treatment with isoniazid, pyrazinamide, rifampicin and ethambutol was prescribed for two months and for four months maintenance therapy with isoniazid and rifampicin was given. On the fourth month of the medical treatment the patient clinically recovered. Since the diagnosis of TB is difficult, high grade suspicion, combination of the radiologic, microbiologic and histopathological examinations are needed to achieve a diagnosis.

No MeSH data available.


Related in: MedlinePlus

A: Chest X-ray revealed bilateral reticulonodullary infiltration. B: Ground-glass density areas in both lungs especially in the left one are seen on thoracic CT.
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fig1: A: Chest X-ray revealed bilateral reticulonodullary infiltration. B: Ground-glass density areas in both lungs especially in the left one are seen on thoracic CT.

Mentions: A sixty-four year old multipar female was admitted to our outpatient clinic with fatigue, abdominal distension, anorexia, hot flushes, and weight loss of 8 kg within eight months. She was hypertensive for a decade but did not report any important disease in her family history. She had no known exposure to TB, never smoked, and never used alcohol. During her physical examination the patient was conscious, cooperative, and showed normal vital signs. The conjunctiva was pale. The examination of the systems was normal except ascites and lymphadenopathies (LAPs). No stigmata of chronic liver disease were found. Multiple painless, mobile, and solid LAPs were found, the biggest being 2 cm in the left cervical and supraclavicular and 3 cm in the bilateral axillary and inguinal regions. The laboratory findings of the patient are summarized in Table 1. Evaluation of the initial laboratory parameters showed mild anemia and leukopenia, a high erythrocyte sedimentation rate (ESR), a high C-reactive protein (CRP) level, increased lactate dehydrogenase (LDH), a albumin globulin rate less than 1, a high CA-125 level, and low vitamin B12. The erythrocytes were normochromic normocytic; mild monocytosis (16%) but no atypical cells were seen in the peripheral blood smear. In the analysis of the ascites fluid, the serum ascitic albumin gradient (SAAG) was <1.1 g/dl, the cell count was 1600 leukocytes/mm3 (70–80% mononuclear), the value of adenozine deaminase (ADA) was 60.4 U/l, and the LDH was high (281 U/L). No malignancy finding was found during the cytological evaluation of the ascites fluid. No bacteriological growth in the ascites fluid culture was observed. She was euthyroid and HIV seronegative. Her hepatitis B and C tests were negative and her coagulation tests were normal. Fecal occult blood revealed a negative result 3 times. No sign of heart failure was detected in both her echocardiography and her physical examination. Chest X-ray revealed bilateral reticulonodullary infiltration (Fig. 1A).


Disseminated tuberculosis in a non immun compromised patient with a complicated diagnosis.

Sahin H, Isık H, Uygun Ilıkhan S, Tanrıverdi H, Bilici M - Respir Med Case Rep (2014)

A: Chest X-ray revealed bilateral reticulonodullary infiltration. B: Ground-glass density areas in both lungs especially in the left one are seen on thoracic CT.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4356042&req=5

fig1: A: Chest X-ray revealed bilateral reticulonodullary infiltration. B: Ground-glass density areas in both lungs especially in the left one are seen on thoracic CT.
Mentions: A sixty-four year old multipar female was admitted to our outpatient clinic with fatigue, abdominal distension, anorexia, hot flushes, and weight loss of 8 kg within eight months. She was hypertensive for a decade but did not report any important disease in her family history. She had no known exposure to TB, never smoked, and never used alcohol. During her physical examination the patient was conscious, cooperative, and showed normal vital signs. The conjunctiva was pale. The examination of the systems was normal except ascites and lymphadenopathies (LAPs). No stigmata of chronic liver disease were found. Multiple painless, mobile, and solid LAPs were found, the biggest being 2 cm in the left cervical and supraclavicular and 3 cm in the bilateral axillary and inguinal regions. The laboratory findings of the patient are summarized in Table 1. Evaluation of the initial laboratory parameters showed mild anemia and leukopenia, a high erythrocyte sedimentation rate (ESR), a high C-reactive protein (CRP) level, increased lactate dehydrogenase (LDH), a albumin globulin rate less than 1, a high CA-125 level, and low vitamin B12. The erythrocytes were normochromic normocytic; mild monocytosis (16%) but no atypical cells were seen in the peripheral blood smear. In the analysis of the ascites fluid, the serum ascitic albumin gradient (SAAG) was <1.1 g/dl, the cell count was 1600 leukocytes/mm3 (70–80% mononuclear), the value of adenozine deaminase (ADA) was 60.4 U/l, and the LDH was high (281 U/L). No malignancy finding was found during the cytological evaluation of the ascites fluid. No bacteriological growth in the ascites fluid culture was observed. She was euthyroid and HIV seronegative. Her hepatitis B and C tests were negative and her coagulation tests were normal. Fecal occult blood revealed a negative result 3 times. No sign of heart failure was detected in both her echocardiography and her physical examination. Chest X-ray revealed bilateral reticulonodullary infiltration (Fig. 1A).

Bottom Line: The long time period between the exposure to TB bacillus and the onset of symptoms cause a delay in diagnosis.On the fourth month of the medical treatment the patient clinically recovered.Since the diagnosis of TB is difficult, high grade suspicion, combination of the radiologic, microbiologic and histopathological examinations are needed to achieve a diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Bülent Ecevit University School of Medicine, Department of Internal Medicine, Zonguldak, Turkey.

ABSTRACT
Tuberculosis (TB) has become a global emergency worldwide. The long time period between the exposure to TB bacillus and the onset of symptoms cause a delay in diagnosis. Herein, we report a case of 64-year-old female patient suffering from dyspepsia, anorexia, weight loss and abdominal pain for the last 8 months. Physical examination, ascites fluid evaluation, chest radiography, ultrasonographic and tomographic scans, histopathological analysis of the lymphadenopathy (LAP) and endometrial tissue revealed TB. A fourfold antituberculous treatment with isoniazid, pyrazinamide, rifampicin and ethambutol was prescribed for two months and for four months maintenance therapy with isoniazid and rifampicin was given. On the fourth month of the medical treatment the patient clinically recovered. Since the diagnosis of TB is difficult, high grade suspicion, combination of the radiologic, microbiologic and histopathological examinations are needed to achieve a diagnosis.

No MeSH data available.


Related in: MedlinePlus