Tuberculosis of the breast with erythema nodosum: a case report.

INTRODUCTION: There has been an increasing number of tuberculosis cases worldwide, but tuberculosis of the breast remains rare. In rare cases this is seen with a cutaneous manifestation of erythema nodosum. CASE PRESENTATION: We report the case of a 33-year-old Chinese woman with tuberculosis of the left breast accompanied by erythema nodosum on the anterior aspect of both lower legs. Due to her poor clinical response to conventional therapy, and the histopathological findings of fine needle aspiration cytology, there were strong indications of tuberculosis. Her clinical diagnosis was confirmed by molecular detection of Mycobacterium tuberculosis complex by polymerase chain reaction. The diagnosis was further confirmed by a second polymerase chain reaction test of erythema nodosum which tested positive for Mycobacterium tuberculosis complex. She received anti-tuberculous therapy for 18 months, and finally underwent residual lumpectomy. During her follow-up examination after 12 months, no evidence of either residual or recurrent disease was present. CONCLUSION: Histopathological features and a high index of clinical suspicion are necessary to confirm a diagnosis of tuberculosis of the breast. Anti-tuberculous therapy with or without simple surgical intervention is the core treatment.

African tick bite fever.

Physicians may encounter unfamiliar diseases as a result of international travel. Fever with rash is an important sign that usually represents initial manifestation of infectious disorders. A 62-year-old Taiwanese woman presented with multiple eschars, a papulovesicular rash, and fever 5 days after returning from South Africa. A biopsy specimen of an eschar had wedge-shaped tissue necrosis, hemorrhage, necrotizing vasculitis of the small venules and arterioles, and a dense perivascular lymphocytic infiltrate in the dermis. Serologically, there was cross reaction with both Rickettsia conorii and R. rickettsii. DNA sequencing demonstrated R. africae, confirming the diagnosis of African tick bite fever. The patient responded well to minocycline. Recognition of the symptoms and signs, and diagnostic tools for different types of rickettsiosis are essential for correct diagnosis and treatment.

Non-typhi Salmonella adrenal abscess in an HIV-infected patient.

We report a case of non-typhi Salmonella adrenal abscess in a patient with human immunodeficiency virus (HIV) infection and thalassaemia minor. Non-typhi Salmonella bacteraemia is common in HIV-infected patients, but infection localized in the adrenal gland is rare. Focal salmonellosis is common in haemoglobinopathy but unusual in thalassaemia minor. This patient was diagnosed by computed tomography (CT) guided aspiration and successfully treated with ciprofloxacin.

Brain abscess: clinical analysis of 53 cases.

Fifty-three cases of brain abscess were treated at Mackay Memorial Hospital from January 1991 through December 2001. The ages ranged from 2 weeks to 84 years, with a peak at 40 to 50 years (11/53, 21%). The male to female ratio was 1.8:1 (34 males, 19 females). The most common presenting symptoms were fever (30/53, 57%), headache (29/53, 55%), and changed mental status (24/53, 45%). The duration of symptoms before hospitalization ranged from several hours to 2 months. A shorter duration of symptoms was associated with poor outcome. The common predisposing factors were otic infection (10/53, 19%), penetrating head trauma and neurosurgery (10/53, 19%), and bacterial endocarditis (5/53, 9%). The leading underlying diseases were diabetes mellitus (12/53, 23%) and/or liver cirrhosis (6/53, 11%), and both were independently associated with increased risk of mortality. Computed tomographic scanning and magnetic resonance imaging facilitated early diagnosis and proper management. Surgical intervention was used together with antibiotics in 33 (62%) of 53 patients in whom the average abscesses diameter was 3.75 cm (range, 2-6 cm). The remaining 20 (38%) patients whose average abscesses diameter was 2.3 cm (range, 1-3.5 cm) were treated with antibiotics only. Culture of material drained from abscesses isolated 27 microorganisms from 19 (58%) of the 33 patients, 81% (22/27) of which were aerobic and 19% (5/27) anaerobic bacteria. The most common pathogen was alpha-hemolytic Streptococcus spp. (6/27, 22%). Most of the patients with Klebsiella pneumoniae isolated from brain abscess, cerebrospinal fluid, and blood cultures were diabetic. A high mortality rate (9/20, 45%) was found in patients with medical treatment. A high index of suspicion is needed for the early diagnosis of brain abscess, particularly in patients with predisposing factors. In this series, early diagnosis using computed tomography and/or magnetic resonance scanning, optimal timing of surgery, and appropriate use of antibiotics were associated with improved outcome.

Haemophilus aphrophilus brain abscess: a case report.

Haemophilus aphrophilus infection is rare, and the organism is infrequently implicated in serious infection. We report a case of a 61-year-old patient who experienced left hemiparesis with dizziness. Computed tomography of the brain demonstrated a lesion with ring enhancement in the right frontotemporal region. Craniotomy was performed, abscess was drained, and H. aphrophilus was isolated. Following the surgical procedure and further antibiotic treatment, the patient recovered completely.