Diagnostic delay in a patient with reactional lepromatous leprosy treated as testicular tuberculosis

Abstract Leprosy is a chronic neglected and stigmatizing disease. Due to involvement of the peripheral nerves, it can result in physical disabilities, deformities, and emotional damage if not diagnosed and treated promptly. This is the case of a young patient with testicular pain and swelling and no improvement after a specific therapeutic scheme for tuberculosis. Clinical and laboratory reevaluation revealed hypoesthetic skin patches associated with post-burn crusted ulcers on the left arm, thickening of ulnar nerves, atrophy of interosseous muscles of the hands, positive skin smear microscopy, and testicular histopathology with numerous bacilli forming globi. These findings indicated lepromatous leprosy with type II reaction.

Hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar / Hydrocele as initial manifestation of genitourinary and miliary tuberculosis / Hidrocele como manifestação inicial da tuberculose geniturinária e miliar

Introducción. La tuberculosis es una enfermedad infectocontagiosa que puede afectar cualquier órgano del cuerpo, incluyendo el sistema genitourinario, representando el 33.7-45.5 % de las tuberculosis extrapulmonares. El objetivo de este trabajo es reportar el caso de un paciente con hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar, enfermedad que no se sospechaba. Presentación del caso. Paciente masculino previamente sano, que consulta a urgencias por orquialgia e hidrocele bilateral, con secreción purulenta por escroto, requiriendo manejo antibiótico intravenoso e hidrocelectomía derecha, con hallazgos intraoperatorios de engrosamiento del epidídimo derecho, y drenaje de material caseoso y purulento. Se realizó epididimectomía ipsilateral, se solicitaron pruebas de detección de bacilos tuberculosos en espécimen y derivado proteico purificado, que fueron positivas. En el postoperatorio presentó sintomatología respiratoria; paraclínicos evidenciaron compromiso pulmonar, pleural y de la vía urinaria por bacilos tuberculosos. Se inicia manejo antituberculoso con evolución satisfactoria. Discusión. El genitourinario es considerado el segundo sistema con mayor afectación de tuberculosis extrapulmonar. El órgano más afectado es el riñón (en un 80 % con respecto a los demás) y el órgano genital es el epidídimo (22 - 55 %). Debe sospecharse en pacientes con síntomas urinarios crónicos sin causa aparente. Se asocia a una alta tasa de morbimortalidad por infertilidad y falla renal. Conclusiones. A pesar de su sintomatología inespecífica y de tratarse de una entidad poco sospechada, la tuberculosis genitourinaria debe descartarse al existir tuberculosis pulmonar. Su diagnóstico y tratamiento oportuno serán de gran importancia para evitar complicaciones secundarias. Cómo citar: Álvarez-Jaramillo J, Ortiz-Zableh AM, Tarazona-Jiménez P, Ortiz-Azuero A. Hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar. MedUNAB. 2019;22(1):71-78. doi:10.29375/01237047.3534

Introduction. Tuberculosis is an infectious disease that can affect any organ in the body, including the genitourinary system, which accounts for 33.7 - 45.5 % of non-pulmonary tuberculosis cases. The purpose of this paper is to report a case of hydrocele as initial manifestation of genitourinary and miliary tuberculosis, which was an unsuspected disease. Case Presentation. Previously healthy male patient is admitted to emergencies due to orchialgia and bilateral hydrocele, with purulent secretion from the scrotum. Was managed with intravenous antibiotic and right hydrocelectomy. Intraoperative findings of thickening of right epididymis and drainage of caseous and purulent material. Ipsilateral epididymectomy was performed; testing for detection of tubercle bacillus in specimen and purified protein derivative was requested, and was found positive. In the postoperative period, respiratory symptoms arose; paraclinical tests found compromised lungs, pleura and urinary tract by tubercle bacillus. Antituberculous treatment was initiated with satisfactory evolution. Discussion. The genitourinary system is the second-most affected system by nonpulmonary tuberculosis. The most affected organ is the kidney (by 80 % compared to the others) and the most affected genital organ is the epididymis (22 - 55 %). It should be suspected in patients with chronic urinary symptoms with no apparent cause. It is associated with a high rate of morbidity and mortality due to infertility and kidney failure. Conclusions. Despite the non-specific symptoms and because it is not normally a suspected entity, genitourinary tuberculosis should be ruled out when pulmonary tuberculosis exists. Timely diagnosis and treatment are very important in order to prevent secondary complications. Cómo citar: Álvarez-Jaramillo J, Ortiz-Zableh AM, Tarazona-Jiménez P, Ortiz-Azuero A. Hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar. MedUNAB. 2019;22(1):71-78. doi:10.29375/01237047.3534

Introdução. A tuberculose é uma doença infecciosa que pode afetar qualquer órgão do corpo, incluindo o sistema geniturinário, representando 33.7 a 45.5 % da tuberculose extrapulmonar. O objetivo deste trabalho é relatar o caso de um paciente com hidrocele como uma manifestação inicial de tuberculose geniturinária e miliar, uma doença que não se suspeitava. Apresentação do caso. Paciente do sexo masculino previamente saudável, que consultou a emergência para orquialgia e hidrocele bilateral, com secreção purulenta do escroto, necessitando de tratamento antibiótico endovenoso e hidrocelectomia direita, com achados intraoperatórios de espessamento do epidídimo direito e drenagem de material purulento e caseoso. Foi realizada uma epididimectomia ipsilateral e foram solicitados exames de bacilos tuberculosos em espécime e derivado proteico purificado, que foram positivos. No pós-operatório, apresentou sintomas respiratórios; testes para-clínicos mostraram comprometimento pulmonar, pleural e do trato urinário devido a bacilos da tuberculose. Começa-se o tratamento antituberculose com evolução satisfatória. Discussão. O sistema geniturinário é considerado o segundo com maior comprometimento da tuberculose extrapulmonar. O órgão mais afetado é o rim (80 % em relação aos demais) e o órgão genital é o epidídimo (22 a 55 %). Deve-se suspeitar em pacientes com sintomas urinários crônicos sem causa aparente. Está associada a uma alta taxa de morbimortalidade devido à infertilidade e insuficiência renal. Conclusões. Apesar de sua sintomatologia inespecífica e de ser uma entidade pouco suspeitada, a tuberculose geniturinária deve ser descartada quando existir tuberculose pulmonar. Seu diagnóstico e tratamento oportuno serão de grande importância para evitar complicações secundárias. Cómo citar: Álvarez-Jaramillo J, Ortiz-Zableh AM, Tarazona-Jiménez P, Ortiz-Azuero A. Hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar. MedUNAB. 2019;22(1):71-78. doi:10.29375/01237047.3534

Tuberculosis Testicular: Reporte de un Caso / Testicular Tuberculosis: Case Report

La tuberculosis es una enfermedad infectocontagiosa emergente con alta morbimortalidad a nivel mundial tanto en su forma pulmonar como extrapulmonar. De hecho, las formas extrapulmonares a pesar de manifestarse en menor porcentaje, permiten la diseminación de la infección a numerosos órganos blanco incluyendo, el sistema genitourinario. Se presenta el caso de un paciente masculino de 50 años de edad, que consulta por presentar masa dolorosa en testículo derecho de aproximadamente 1 mes de evolución, con salida de material purulento fétido y persistente en hemiescroto, sin respuesta al tratamiento antimicrobiano ambulatorio, acompañado de disnea e hipoventilación en campo pulmonar izquierdo, y antecedente de pérdida de peso y tos con expectoración color verde a café desde hace 6 meses. Es sometido a orquiectomía radical más escrotatectomía observándose por los estudios patológicos y histoquímicos del tejido, una inflamación crónica granulomatosa con necrosis caseosa central y positiva a la coloración de Ziehl Nielssen. Por los hallazgos de la patología más los clínicos e imagenológicos a nivel pulmonar, se hace diagnóstico de tuberculosis pulmonar con diseminación a testículo y escroto. El paciente es sometido a tratamiento antifímico con mejoría.

Tuberculosis is an emerging infectious contagious disease with high morbidity and mortality worldwide both in its pulmonary and extrapulmonary forms. In fact, extrapulmonary forms, despite manifesting themselves in lesser percentage, allow the dissemination of infection to numerous target organs including, the genitourinary system. We present the case of a 50-year-old male patient, who consults for painful mass in the right testicle of approximately 1 month of evolution, with a leakage of fetid and persistent purulent material in hemiescrotum, without response to outpatient antimicrobial treatment, accompanied by dyspnea and hypoventilation in the left lung field, and a history of weight loss and cough with expectoration from green to brown for 6 months. He underwent radical orchiectomy plus scro- toctenomy. Chronic and granulomatous inflammation with central caseous necrosis and positive to the coloration of Ziehl Nielssen were observed by pathological and histochemical tissue studies. For the findings of the pathology plus the clinical and imaging findings at the pulmonary level, a diagnosis of pulmonary tuberculosis with spread to the testicle and scrotum is made. The patient undergoes antifimic treatment with improvement.

Incidentally detected tuberculous prostatitis with microabscess

ABSTRACT Tuberculous prostatitis is a rare and often overlooked entity that may mimic prostatic adenocarcinoma on imaging exams, especially multiparametric magnetic resonance imaging (MRI) of the prostate. Detection of a prostatic abscess is a clue to the correct diagnosis.

Tuberculosis genital en un paciente con masa testicular / Genital tuberculosis in a patient with testicular mass

El tracto genitourinario es el segundo sitio más común para la infección tuberculosa después de los pulmones. La tuberculosis genital masculina es rara y la infección testicular suele ser secundaria a la del epidídimo.Si se diagnostica a tiempo la tuberculosis testicular puede ser tratada con medicación y/o resección quirúrgica. Esta localización puede signifcar un reto diagnóstico ya que puede confundirse como una neoplasia testicular por el cuadro clínico que presenta [1]. Presentamos el caso de un paciente con dolor en testículo de varios años de evolución, destacando los hallazgos anátomo-patológicos para el diagnóstico defnitivo.

First reported case of fulminant TB with progression of infection from lungs to the genitourinary region

ABSTRACT Although tuberculosis (TB) is a curable disease, it continues to be one of the leading infections associated with death in the world. Extra-pulmonary TB (EPTB) occurs in approximately 10% of the total cases, presenting with lymph nodes, pleura, bone and genitourinary tract as the most common locations. Genitourinary tuberculosis, the second most common EPTB, is very difficult to diagnose unless there is a high index of suspicion. Isolated TB orchitis or prostatitis without clinical evidence of renal involvement is a rare entity among genitourinary tuberculosis. We presented the first reported case of TB prostatitis and orchitis associated with pulmonary TB and the presence of an acute massive caseous pneumonia in an immunocompetent man. Despite the anti-TB therapy, the patient presented a rapid progression of disease and deterioration of general conditions taking to death, which occurred four days after TB treatment had started. Disseminated TB is a relatively uncommon cause of acute massive caseous pneumonia; however, there should always be suspicion of the disease, since it is a potentially treatable cause. This rare case supports the assertion that TB should be considered as an important differential diagnosis of genitourinary tumors irrespective of evidence of active TB elsewhere in the body.

Tuberculosis genitourinaria en paciente con sida / Genitourinary tuberculosis in an AIDS patient

Introducción: la tuberculosis es una enfermedad con una alta prevalencia en los países en vías de desarrollo. Entre los casos de tuberculosis extrapulmonar, la tuberculosis genitourinaria es común y esta situación se acentúa en los pacientes con sida. Objetivo: describir las características clínicas de un paciente que presentó tuberculosis genitourinaria detectada mediante el empleo de la reacción en cadena de la polimerasa. Presentación del caso: paciente masculino de 34 años de edad, seropositivo al virus de la inmunodeficiencia humana desde 2004, con antecedentes de tuberculosis pulmonar, que ingresa en junio de 2014 en el Hospital del Instituto de Medicina Tropical Pedro Kourí refiriendo fiebre de alrededor de dos meses de duración, intermitente, vespertina, acompañada de sudoraciones profusas y pérdida de peso importante. Además, se constata la presencia de disuria desde el comienzo de la fiebre. Recibió varios tratamientos con antibióticos sin respuesta. Se detecta Mycobacterium tuberculosis en la orina del paciente mediante la reacción en cadena de la polimerasa. Tres meses después, es reevaluado y se encuentra afebril, con aumento de peso, evolución clínica favorable y continúa con la primera fase de tratamiento anti-tuberculosis. Conclusiones: el evento ocurrido en este caso sugiere que los facultativos deben pensar en el diagnóstico de la tuberculosis genitourinaria en los pacientes con sida(AU)

Introduction: tuberculosis is highly prevalent in developing countries. Genitourinary tuberculosis is a common type of extrapulmonary tuberculosis, particularly in AIDS patients. Objective: describe the clinical characteristics of a patient with genitourinary tuberculosis detected by polymerase chain reaction. Case presentation: amale 34 year-old patient seropositive for human immunodeficiency virus since the year 2004 and a history of pulmonary tuberculosis is admitted in 2014 to the hospital at Pedro Kouri Tropical Medicine Institute. The patient had had intermittent vespertine fever for about two months as well as profuse sweating and considerable weight loss. Dysuria had also been present since the onset of fever. The patient had received several antibiotic treatments with no response. Mycobacterium tuberculosis was detected in the patient's urine by polymerase chain reaction. Re-evaluation performed three months later found that the patient was afebrile, had gained weight and his clinical evolution was favorable. The patient continues at the first stage of tuberculosis treatment. Conclusions: the event described suggests that physicians should consider genitourinary tuberculosis in their evaluation of AIDS patients(AU)

Polaciúria incapacitante para a vida usual. Relato de tuberculose da bexiga. A tuberculose permanece no rol do diagnóstico diferencial da maioria das doenças / Incapacitating pollakiuria affecting daily life. A case report of tuberculosis of the bladder. Tuberculosis remains on the list of the differential diagnoses for most diseases

A tuberculose (TB) é dos mais graves problemas de saúde humano e associa-se a pobreza, incipiência do sistema de saúde, deficiência de gestão que dificulta a diminuição de doenças de determinismo social, epidemia do vírus da imunodeficiência humana e imunodeficiência adquirida e multirresistência do M. tuberculosis. O acometimento extrapulmonar ocorre em 15% dos casos de TB e pode evoluir com amesma sintomatologia geral do acometimento pulmonar, com variações na dependência de sua localização e gravidade. Este relato apresenta paciente com hematúria e polaciúria incapacitante para a vida social, associada inicialmente à neoplasia, e determinada pela TB geniturinária, com diagnóstico após histopatologia de espécime clínico obtido da bexiga, em que o tempo longo para o diagnóstico foi determinante para grave sequela. Objetiva alertar para a TB como doença permanente no Brasil ea necessidade de ser considerada sempre como diagnóstico diferencial de doenças pulmonares ou extrapulmonares.

Tuberculosis (TB) is among the most serious human health concerns and is associated with poverty, limited availability of health care services and bad management, all of which negatively affect the possibility of reducing socially-determined diseases, such as HIV/AIDS epidemics and multidrug resistant M. tuberculosis. Extrapulmonary involvement occurs in 15% of TB cases and can develop with the same overall symptomatology of exclusively pulmonary involvement, with smaller variations depending on location and severity. This report presents a patient with hematuria and pollakiuria with incapacitating effects on social life, initially thought of as a malignancy and later identified as genitourinary TB. Diagnosis was based on histopathology of clinical specimens from the bladder. Time elapsed between onset and diagnosis led to considerable sequelae. This report aims at raising awareness of TB as a permanent concern in Brazil and of the need to always considered it as a differential diagnosis of pulmonary or extrapulmonary disease.

Perfil epidemiológico dos pacientes portadores de tuberculose extrapulmonar atendidos em hospital da rede pública no estado do Maranhão / Epidemiological profile of patients with extrapulmonary tuberculosis in a public hospital in state of Maranhão

JUSTIFICATIVA E OBJETIVOS: Embora conhecida desde a antiguidade, a tuberculose (TB) continua preocupando as autoridades sanitárias até os dias de hoje. O presente estudo teve como objetivo descrever o perfil clínico e epidemiológico dos pacientes diagnosticados com tuberculose extrapulmonar (TBEP) atendidos em hospital da rede pública de saúde no estado do Maranhão. MÉTODO: Trata-se de uma análise descritiva, com abordagem quantitativa. Foram analisados 133 prontuários de pacientes portadores de TBEP que receberam atendimento na unidade hospitalar referida no período de abril de 2007 a abril de 2009. RESULTADOS: Verificou-se predomínio do sexo masculino (61,4%), adultos jovens (51,8%) e com relação aos aspectos clínicos, apenas 14,3% dos pacientes apresentaram TBEP. A baciloscopia foi realizada em 86% dos pacientes; e destes apenas 9% apresentaram resultado positivo. A cultura foi empregada em 8,3%. Quanto à evolução 58,6% obtiveram cura, três foram a óbito (2,2%) e houve apenas três casos de abandono (2,2%) do Programa de Controle de Tuberculose (PCT) do Município. CONCLUSÃO: Este estudo possibilitou conhecer características da TBEP na população estudada, além de avaliar, indiretamente,o serviço de saúde dirigido ao controle da doença.

BACKGROUND AND OBJECTIVES: Although it is widely known since very ancient times, tuberculosis (TB) continues to preoccupy medical authorities nowadays. This study describes the clinical and epidemiological profile of extrapulmonary tuberculosis(ETB) cases assisted in a TB specialty public hospitallocated in São Luís, MA. METHOD: A descriptive analysis with a quantitative approach was made in order to support this study; 133 medical reports were analyzed and data from individual tuberculosis Investigation files and tuberculosis case registries were compiled, within the time span between April/2007 and April/2009. RESULTS: Disease occurred predominantly in males (61.4%),and in young adults (51.8%). As for the clinical presentation,only 14.3% of the total patients were diagnosed with extrapulmonary tuberculosis. Bacilloscopy was performed in 86% of these patients, within which only 9% had a positive result. Culture was performed in only 8.3% of patients. Among the patients treated by the Municipal Tuberculosis Control Program (PCT),58.6% were cured; 2.2% died and 2.2% (3 cases) abandoned treatment. CONCLUSION: This investigation permits an improved understanding of extrapulmonary tuberculosis characteristics in this particular setting and enables an indirect evaluation of the public healthcare system treatment of this disease.

Orquitis tuberculosa aislada / Isolated tuberculous orchitis

Presentación de un caso poco frecuente de tuberculosis genital aislada, en un hombre de 28 años, no fumador, sin antecedentes clínicos significativos...

Prostatic tuberculosis: case report / Tuberculosis prostática: informe del caso

CONTEXT: Tuberculosis of the prostate has mainly been described in immunocompromised patients. However, it can exceptionally be found as an isolated lesion in immunocompetent patients. CASE REPORT: We report a case of prostatic tuberculosis in a young, healthy and immunocompetent patient with unremarkable findings from intravenous urographic examination. Computed tomography showed an abscess in the prostate and Mycobacterium tuberculosis was isolated in a urine culture. Treatment with isoniazid, rifampin and pyrazinamide was successful.

CONTEXTO: La tuberculosis prostática ha sido principalmente descrita en pacientes inmunodeprimidos. Sin embargo, es excepcional como lesión aislada en pacientes inmunocompetentes. CASO CLINICO: Describimos el caso de un varón sano e inmunocompetente con tuberculosis prostática y hallazgos irrelevantes en la urografía de eliminación realizada. La tomografía computerizada (TC) mostró un absceso en próstata, aislándose en el urocultivo Mycobacterium tuberculosis. El tratamiento con isoniazida, rifampicina y pirazinamida fue exitoso.

Probable tuberculosis en lesión ulcerada en pene / probable tuberculosis in ulcer in penis

Presentamos el caso de un varón de 52 años de edad que presentaba una lesión ulcerativa en el glande, de 20 años de evolución, habiendo recibido diferentes tipos de tratamiento sin éxito. La lesión presentaba bordes irregulares, consistencia dura y no había dolor. El estudio histopatológico mostró granuloma necrótico, BAAR positivo, sugestivo de TBC.

La tuberculosis genitourinaria en el siglo XXI / Genitourinary tuberculosis in the 21st century

Tuberculosis is a major health problem in both underdeveloped and industrialized nations. Each year there is an estimated 8 million new cases of tuberculosis (TB) with 2 million deaths. TB is an opportunistic infection affecting primarly lower social economic classes and individuals whose immune system are compromised by age (very young and elderly), infection (HIV) and recipients of immune modulators (organ transplantation, collagen disease). Twenty percent of patients with TB may develop genitourinary (GU) tuberculosis. Pelvic infection in the female can mimic malignancy. In the past "classic" genito-urinary tuberculosis has developed in conjunction with pulmonary or miliary infection. Patients now present with isolated (i.e. adrenal, renal, genital or pelvic) infection. Diagnosis of GU TB infection is difficult. Newer molecular biologic tools i.e. polymerase chain reaction (PCR) provide improved diagnostic methods. CT scans are an effective imaging tool. Retropeirtoneal and intraperitoneal TB disease can be evaluated and treated by laparoscopic surgical procedures. Despite the advantages of the newer technology, TB of the genito-urinary continues to significant challenge to the practitioner because of Mycobacterium tuberculosis that is resistant to current anti-TB drugs and "non-classic" presentation of GU infection.

La tuberculosis es un problema de salud importante en las naciones industrializadas como también en los países en vías de desarrollo. Cada año se estiman 8 millones de nuevos casos de tuberculosis (TBC) con 2 millones de muertes. La TBC es una infección oportunista que afecta en forma primaria a individuos de clases sociales mas bajas o a aquellos que presentan compromiso del sistema inmune debido a la edad (niños o ancianos), infecciones (HIV) o al tratamiento con moduladores del sistema inmune (trasplante de órganos, enfermedad del colágeno). El 20% de los pacientes con TBC pueden contraer tuberculosis genitourinaria (TGU). La infección pelviana en la mujer puede simular una enfermedad maligna. En el pasado, la tuberculosis genitourinaria "clásica" se desarrollaba junto con la infección pulmonar o miliar. Ahora los pacientes se presentan con la infección aislada (suprarrenal, renal, genital o pelviana). El diagnostico de la TGU es difícil. Nuevas herramientas de la biología molecular, por ejemplos la reacción en cadena de la polimerasa, ofrecen mejores métodos diagnósticos. La tomografía computarizada es una herramienta efectiva para obtener imágenes. Las TBC retroperitoneal e intraperitoneal pueden ser evaluadas y tratadas mediante procedimientos quirúrgicos laparoscópicos. A pesar de las ventajas de las nuevas tecnologías, la TBC es aún un desafío para el medico debido a que Mycobacterium tuberculosis es resistente a los antibióticos actuales y a la forma de presentación atípica de la infección genitourinaria.

Orientación clínica ante una adenopatía cervical a propósito de un caso / Case review: Clinical approach to a cervical adenophaty

El crecimiento patológico de los ganglios linfáticos o adenopatías, registra causas muy variadas y pueden ir desde una banal importancia clínica hasta aquellas de origen tumoral; es por ello que el diagnóstico eficaz y oportuno de su etiología se vuelve fundamental en la evolución clínica de los pacientes. La conducta a seguir ante una adenopatía se basa en la historia clínica, la exploración física y las pruebas complementarias.Presentamos el caso de un paciente de 41 años, sexo masculino, que consulta por presentar una adenopatía cervical, sin datos relevantes en la anamnesis y el examen físico; luego de una secuencia de estudios orientados científicamente, se llega al diagnóstico de tuberculosis ganglionar más SIDA. Se presenta el caso con el objetivo de analizar la importancia de hallar precozmente el origen de una adenopatía, que aparentemente no tenía mayor repercusión en el desarrollo de la vida del paciente y se realiza la revisión bibliográfica de sus posibles causas.

The pathologic growth of the lymph nodes is called adenopathies. There are multiple causes that vary from without clinical importance to neoplasic tumors. That is why the early diagnosis of its etiology is fundamental in our patient’s clinical evolution. The study of an adenophaty is based in the clinical history, physical exam and the complementary lab tests.We present a case of a 41 years old male patient, who has a cervical adenophaty. Without relevant information in the clinical history and physical exam. After a sequence of studies and lab analysis we concluded that he presented ganglionar tuberculosis plus AIDS. We present this case to study the importance of finding early the origin of an adenophaty that apparently has no repercussion in patient’s life and the references about its possible causes.

Tuberculosis vegetante / Vegetans tuberculosis

Imformamos un caso de tuberculosis vegetante perianal. Un hombre de 59 años presentaba múltiples vegetaciones fistulizadas alrededor del ano y genitales. El disgnóstico fue confirmado por cultivo. La cirugía y agentes tuberculostáticos fueron efectivos. Presentamos una revisión bibliográfica reciente