An Indonesian female with peritoneal tuberculosis mimicking ovarium carcinoma: A rare case.

INTRODUCTION: Peritoneal tuberculosis is rare when patients with abdominal pain need to be considered for tuberculosis testing. CASE PRESENTATION: An Indonesian female, 19 years old, complained of abdominal pain and enlargement. Laboratory examination is abnormal, including thrombocytosis of 687,000/uL and Ca-125 of 3483 U/mL. Ultrasound and CT scan of the abdomen showed cystic lesions in the pelvic cavity, enlargement of the abdominal lymph nodes, and ascites. She was diagnosed with ovarian carcinoma. The patient underwent surgery and obtained nodules such as tuberculoma. Nodule biopsy results showed granulomatous inflammation. The patient was given anti-tuberculosis drug (ATD) category 1 for 2 months and continued with category 2 for 7 months (total 9 months of treatment). The prognosis showed improvement, and weight increased by 15 kg (from 40 kg to 55 kg). DISCUSSION: The challenge of peritoneal tuberculosis is the absence of specific signs and symptoms. Therefore, tuberculosis testing must be considered if tuberculosis is endemic in patients with abdominal pain who do not show a good prognosis when treated according to the developed signs and symptoms. CONCLUSION: Suspicion of tuberculosis infection should be evaluated in endemic tuberculosis because some tuberculosis infections, such as peritoneal tuberculosis, do not have specific signs and symptoms.

Indonesian female with bilateral chylothorax and mediastinal non-Hodgkin lymphoma: A case report.

BACKGROUND: Bilateral chylothorax is leakage and accumulation of lymph fluid in the pleural space on both sides of the lung and in non-traumatic cases, caused mainly by lymphoma. CASE PRESENTATION: An Indonesian female, 34 years old, complained of short breath, cough, and swelling in several areas (neck, breast, and hands). Chest X-ray and thorax CT scan showed the anterior mediastinal mass and bilateral pleural effusion. Pleural fluid from both hemithorax was yellow and turbid but odorless. Aerobic culture and cytology of pleural fluid were negative. Triglyceride (TG) of both pleural fluids was >110 mg/dL with the ratio of cholesterol/triglyceride of pleural fluid <1 supporting chylothorax. The core biopsy analysis was negative. Non-Hodgkin lymphoma was established by open thoracotomy biopsy and immunochemistry examination. Chylothorax prognosis was an improvement which was reduced after chest tube insertion. On the outpatient, the patient plans chemotherapy with R CHOP regimen (Rituximab + Cyclophosphamide, prednisone, doxorubicin, and vincristine). DISCUSSION: Malignancy is the primary cause of non-traumatic chylothorax and thoracotomy is used to repair the thoracic duct. CONCLUSION: Bilateral chylothorax and non-Hodgkin lymphoma were confirmed based on pleural fluid analysis, thoracotomy open biopsy, and immunochemistry examination.

Diagnostic approach and management of bilateral pneumothorax due to silicosis in Indonesian male: A rare case.

BACKGROUND: Bilateral pneumothorax due to silicosis was a rare case, so diagnosis and management are essential to the report. CASE PRESENTATION: A 29-year-old Indonesian male complained of shortness of breath, cough, and body weight loss. Medical history interpreted pulmonary tuberculosis and successful treatment in 6 months. Physical examination and chest radiograph showed bilateral pneumothorax. The patient was diagnosed with bilateral pneumothorax due to silicosis and treated usage chest tube insertion and video-assisted thoracoscopic surgery (VATS). The patient has improved his condition after a few days of receiving post-surgery treatment. DISCUSSION: Exposure to silica can determine through a spectrophotometer. The therapy of silicosis is still challenging because of the disease's progressivity and complications. CONCLUSION: Silicosis is not only a chronic and progressive disease but also leads to many complications, including bilateral pneumothorax.

Moxifloxacin concentration correlate with QTc interval in rifampicin-resistant tuberculosis patients on shorter treatment regimens.

Background: Drug-resistant tuberculosis (DR-TB) continues to be a global threat. Moxifloxacin is one of the components of the shorter treatment regimen which is suspected to increase the risk of QT prolongation, although it is also likely to be the most effective against DR-TB. A study to evaluate the correlation between the concentration of moxifloxacin and QTc interval in RR-TB patients who received shorter regimens is needed. Methods: This was an observational study in 2 groups of RR-TB patients on shorter treatment regimens (intensive phase and continuation phase), contain moxifloxacin with body weight-adjusted dose. Blood samples were collected at 2 h after taking the 48th-hour dose and 1 h before taking the 72nd-hour dose. Results: Forty-five RR-TB patients were included in this study. At 2 h after taking the 48th-hour dose, the mean of QTc interval in intensive phase and continuation phase was 444.38 ms vs. 467.94 ms, p = 0.026, while mean of moxifloxacin concentration in intensive phase and continuation phase was 4.3 µg/mL vs. 4.61 µg/mL, p = 0.686). At 1 h before taking the 72nd-hour dose, both moxifloxacin concentration and QTc interval in intensive phase and continuation showed no significant difference with p-value of 0.610 and 0.325, respectively. At 2 h after taking the 48th-dose, moxifloxacin concentration did not correlate with QTc interval, both in intensive phase (p = 0.576) and in continuation phase (p = 0.691). At 1 h before taking the 72nd-hour dose, moxifloxacin concentration also did not correlate with QTc interval in intensive phase (p = 0.531) and continuation phase (p = 0.209). Conclusions: Our study found that moxifloxacin concentration did not correlate with QTc interval, which indicates the safe use of moxifloxacin on QTc interval. In addition to close monitoring of QTc interval, the clinicians should also consider other variables which potentially increase risk for QTc prolongation in DR-TB patients who received shorter treatment regimens.

Correlation of Moxifloxacin Concentration, C-Reactive Protein, and Inflammatory Cytokines on QTc Interval in Rifampicin-Resistant Tuberculosis Patients Treated with Shorter Regimens.

BACKGROUND: Drug-resistant tuberculosis (DR-TB) is a global health concern. QTc prolongation is a serious adverse effect in DR-TB patients receiving a shorter regimen. This study aimed to evaluate the correlation of moxifloxacin concentration, CRP, and inflammatory cytokines with QTc interval in DR-TB patients treated with a shorter regimen. METHODS: This study was performed in 2 groups of rifampicin-resistant (RR-TB) patients receiving shorter regimens. Correlation for all variables was analyzed. RESULTS: CRP, IL-1ß, and QTc baseline showed significant differences between 45 RR-TB patients on intensive phase and continuation phase with p-value of <0.001, 0.040, and <0.001, respectively. TNF-α and IL-6 between RR-TB patients on intensive phase and continuation phase showed no significant difference with p=0.530 and 0.477, respectively. CRP, TNF-α, IL-1 ß, and IL-6 did not correlate with QTc interval in intensive phase (p=0.226, 0.281, 0.509, and 0.886, respectively), and also in continuation phase (0.805, 0.865, 0.406, 0.586, respectively). At 2 hours after taking the 48th-dose, moxifloxacin concentration did not correlate with QTc interval, both in intensive phase (p=0.576) and in continuation phase (p=0.691). At 1 hour before taking the 72nd-hour dose, moxifloxacin concentration also did not correlate with QTc interval in intensive phase (p=0.531) and continuation phase (p=0.209). CONCLUSION: Moxifloxacin concentration, CRP, and inflammatory cytokines did not correlate with QTc interval in RR-TB patients treated with shorter regimens. The use of moxifloxacin is safe but should be routinely monitored and considered the presence of other risk factors for QTc prolongation in RR-TB patients who received shorter regimens.

Hemorrhagic pleural effusion in Indonesian male with pulmonary tuberculosis: A rare case.

BACKGROUND: Patients with hemorrhagic pleural effusion who live in tuberculosis endemic areas are recommended to perform adenosine deaminase (ADA) test. CASE PRESENTATION: A Javanese 22-year-old male complained of shortness of breath and cough with phlegm for 1 week, and worsened 3 days before being admitted to the hospital. The X-ray results showed pleural effusion, and hemorrhagic pleural effusion examination showed an increase in lymphocytes (60.2%), lactate dehydrogenase/LDH (2624 U/L), and cell count (4584 cells/mm3), and the ADA test obtained 49 IU/L. The water-sealed drainage (WSD) was installed and first-line anti-tuberculosis drug (ATD) was given for 1 month. After showing improvement in the first month, the first-line ATD was continued until 6 months. DISCUSSION: Patients with hemorrhage pleural effusion who live in tuberculosis endemic areas are recommended to perform differential diagnosis of hemorrhage pleural effusion and pulmonary tuberculosis. The use of the first-line ATD in hemorrhagic pleural effusion and pulmonary tuberculosis needs to be evaluated in the first month to detect improvement, otherwise, the medication is stopped and other investigations are carried out. CONCLUSION: Successful management of hemorrhagic pleural effusion and pulmonary tuberculosis depends on early diagnosis.

The role of C-Reactive protein as an inflammatory marker to predict prolonged QTc interval in rifampicin-resistant tuberculosis patients: A case-control study.

BACKGROUND: long-term use of anti-tuberculosis drugs (ATD) increases the risk of QTc prolongation, while C-reactive protein (CRP) can be used as an inflammatory marker of Mycobacterium tuberculosis infection.Objective: correlation of CRP on the QTc interval in Rifampicin-resistant tuberculosis (RR-TB) patients with the short regimen. METHODS: An observational study was conducted in Rifampicin-resistant tuberculosis (RR-TB) patients from 2 groups, patients on intensive phase and patients on continuation phase. CRP levels were measured from blood samples and measured automatically using the immunoturbidimetric assay. QTc interval was calculated using electrocardiography. Levels of CRP levels and QTc interval between the 2 groups were analyzed. The statistical analysis used includes the independent t-test, Mann Whitney test, and Rank Spearman test with p = 0.05. RESULTS: Forty-five eligible RR-TB patients were included in this study. CRP levels and QTc intervals between 2 groups (intensive and continuation phase) showed significant difference with p < 0.001 but found no significant correlation of CRP levels and QTc interval in both intensive and continuation phase with p = 0.226 and 0.805, respectively. A higher level of CRP strongly indicated the inflammation caused by RR-TB infection at the early phase of the disease, but not correlated with QTc interval in RR-TB patients. CONCLUSION: Levels of CRP and QTc interval do not correlate in RR-TB patients and can not be used to be the marker of QTc prolongation in RR-TB Patients.

Correlation of inflammatory cytokines on corrected QT interval in rifampicin-resistant tuberculosis patients.

BACKGROUND: The cases of Rifampicin-Resistant Tuberculosis (RR-TB) in our country have increased every year and RR-TB deaths are thought to be caused by prolongation of the QTc interval due to side effects of anti-tuberculosis drugs. Thus, cytokines are needed to be used as early markers of prolongation of the QTc interval in RR-TB patients. OBJECTIVE: This study aims to analyze the correlation of inflammatory cytokines on QTc interval in RR-TB patients who received shorter regimens. METHODS: This study uses a case-control study with a time series conducted in the period September 2019 to February 2020 in one of the referral hospitals for Tuberculosis in Indonesia. Cytokines levels from blood samples were measured using the ELISA method, while QTc intervals were automatically recorded using an electrocardiography machine. The statistical analysis used was the Chi-square test, Man Whitney test, Independence t-test, and Spearman-rank test with p < 0.05. RESULTS: There was no significant correlation between inflammatory cytokines and QTc prolongation in intensive phase which TNF-α value (6.8 pg/ml; r = 0.207; p = 0.281), IL-1ß (20.13 pg/ml; r = 0.128; p = 0.509), and IL-6 (43.17 pg/ml; r = -0.028; p = 0.886). Meanwhile, in the continuation phase, the values for TNF-α (4.79 pg/ml; r = 0.046; p = 0.865), IL-1ß (7.42 pg/ml; r = -0.223; p = 0.406), and IL- 6 (40.61 pg/ml; r = -0.147; p = 0.586). CONCLUSION: inflammatory cytokines (TNF-α, IL-1ß, and IL-6) cannot be used to identify QTc interval prolongation in RR-TB patients who received shorter regimens.

Level of serum IL-33 and emphysema paraseptal in clove cigarette smoker with spontaneous pneumothorax: A case report.

A young male clove cigarette smoker experienced spontaneous pneumothorax and later paraseptal emphysema was detected on high-resolution computed tomography (HRCT) scan without respiratory symptoms. Smoking is a known risk factor for emphysema. Paraseptal emphysema is a type of emphysema that rarely causes respiratory symptoms, nevertheless, usually accompanied by spontaneous pneumothorax. Interleukin 33 (IL-33) is an alarmin cytokine that belongs to the IL-1 family. The effects of IL-33 depend on its structure. In its mature form, it is a cytokine alarmin that binds to ST2 (suppression of tumorigenicity) receptors on the surface of macrophages and innate immune cells to drive Th1/Th2 immune responses, causing oxidative stress, and increased IL-33 production causes polarization of alveolar macrophages to an M2 phenotype. In this study, long-term exposure to clove cigarette smoke caused an increased serum level of IL-33 (43.72 pg/mL) and paucigranulocytic airway inflammation. In paucigranulocytic inflammation, IL-33 is involved in lung parenchymal damage presumably through oxidative stress, activation of alveolar macrophage and increased MMP12 secretion, resulting in alveolar destruction and airspace enlargement.