The diagnostic challenge of pulmonary Kaposi's sarcoma with pulmonary tuberculosis in a renal transplant recipient: a case report.

We report a case of a 39-year-old, HIV-negative, post renal transplant patient who developed mucocutaneous Kaposi's sarcoma with lung parenchymal involvement and concurrently culture proven pulmonary tuberculosis. To the best of our knowledge, this is the first case report of this combination, which presented with cavitating lung nodules and responded well to withdrawal of immunosuppressive drugs beside antituberculous treatment.

Chronic eosinophilic pneumonia presenting with recurrent massive bilateral pleural effusion : case report.

We describe a rare case of a 29-year-old woman with chronic eosinophilic pneumonia (CEP) presenting with massive bilateral pleural effusion leading to respiratory failure, a complication that was not reported before with CEP. The patient was successfully managed with ventilatory support and steroid therapy. On long-term follow-up, she remained well, receiving a low maintenance dose of prednisone without evidence of relapse of the disease.

Treatment outcome of tuberculosis among Saudi nationals: role of drug resistance and compliance.

OBJECTIVE: Recent studies have demonstrated a high prevalence of multiresistant Mycobacterium tuberculosis (MDR-TB) in Saudi Arabia. In this study, we assessed the impact of this and other factors on the treatment outcome of tuberculosis among Saudi nationals. METHODS: We studied all patients (147 patients) with a culture-proven diagnosis of tuberculosis seen at the King Khalid National Guard Hospital (KKNGH), Jeddah, Saudi Arabia from June 1993 to June 1999. Treatment outcome was classified as success or failure based on the clinical assessment, improvement or deterioration of chest X-rays, and results of follow-up sputum examination. RESULTS: Of the 147 patients, only 126 completed the follow-up program. Treatment was found to be successful in 102 (81.0%) and unsuccessful in 24 (19.0%) of these 126 patients. However, treatment success is much less (102/147; 69.4%) and failure is much higher (45/147; 30.6%) if the 21 patients who were lost to follow-up are regarded as treatment failures. The prevalence of poor compliance and multiply drug-resistant Mycobacterium tuberculosis were found to be significantly higher among those with treatment failure than among those in whom treatment was successful. There was no significant difference in treatment outcome between the different age groups. However, failure of treatment was observed to be more common (P < 0.001) among males (35 patients; 46.7%) than among females (10 patients; 13.9%). This could be explained mainly by the significantly higher prevalence of non-compliance among males (44%) than among females (15.3%). There were no significant differences in the symptoms, radiologic findings, clinical presentation (pulmonary versus extrapulmonary), social background or drug resistance between genders. CONCLUSION: Successful treatment outcome among Saudi Nationals seen at the KKNGH in 1993-99 was below the rate recommended by the WHO, and failed treatment was associated with poor compliance, male gender and drug-resistant Mycobacterium tuberculosis. These results emphasize the importance of culture and sensitivity tests for Mycobacterium tuberculosis and close supervision of patients taking antituberculosis medications.

Increasing resistance of M. tuberculosis to anti-TB drugs in Saudi Arabia.

The incidence of drug resistance in Mycobacterium tuberculosis (MTB) isolated from our hospital between April 1996 and March 1998 was compared with an earlier study (1993-1995). Thirty (29.7%) of 101 MTB isolates were resistant to one or more anti-TB drugs and 21 (20%) of 101 were multi-drug resistant M. tuberculosis (MDR-TB). Resistance was most common to isoniazid (28.7%), followed by streptomycin (22.8%) and rifampicin (20.8%). Resistance to pyrazinamide and ethambutol was 7.9 and 6.9%, respectively. There was a three-fold increase in resistance compared with the earlier study.

Sarcoidosis in the western region of Saudi Arabia.

BACKGROUND AND AIM OF THE WORK: To review a general hospital's experience with sarcoidosis and the clinical pattern of the disease among the Saudis. METHODS: Retrospective file review was carried out of all patients with proven diagnosis of sarcoidosis in a general hospital in Western Saudi Arabia over a period of 11 years (1985-1996). RESULTS: Twenty-one patients, of whom 17 were native Saudis, had been diagnosed to have sarcoidosis during the study period. There were 5 males and 16 females. The mean age was 45 years with a range of 20-69 years. The commonest presentations were cough (43%), dyspnoea (43%), joint pain (38%), hepatomegaly (29%), splenomegaly (24%) and lymphadenopathy (24%). The biochemical analysis showed raised alkaline phosphatase in 66%, calcium level was elevated in 5% and urinary calcium was elevated in 3 out of 7 patients tested. Angiotensin Converting Enzyme was elevated in 11 of 15 patients. Tuberculin test was negative in all those tested (17 patients). The patients were classified using the Siltzbach staging into 0-3. Stage 0 (14%), Stage 1 (33%), Stage 2 (43%) and Stage 3 (10%). The gallium scan was positive in 90% of those who were tested (7 patients). The diagnosis in all except one patient was proven histologically. The outcome was favourable in most patients (76%), though 52% received active treatment. CONCLUSIONS: Sarcoidosis does occur in native Saudis. On comparison with Western patterns of the disease, there is a female predominance and relative lack of cardiac, eye, parotid and central nervous system involvement. The rarity of cardiac and central nervous system involvement was comparable with other Middle Eastern studies. Sarcoidosis, though rare in our community, should still be considered in the differential diagnosis of patients with the typical presentation after excluding tuberculosis which is epidemic.

Erratum: Multidrug-resistant tuberculosis.

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The diagnostic challenge and management of pulmonary Kaposi's sarcoma in renal transplant recipients.

Kaposi's sarcoma is a multicentric low grade tumor that usually begins with the development of violaceous skin lesions and is associated with the presence of human herpes virus 8. Kaposi's sarcoma has been described in immunocompromised patients, particularly following renal transplantation, with cutaneous involvement being the most salient finding. Infectious and non-infectious pulmonary disorders in immunocompromised patients can simulate the radiological manifestations of pulmonary Kaposi's sarcoma. This report highlights the dilemma in reaching an accurate diagnosis of pulmonary Kaposi's sarcoma as a complication of immunosuppression post-renal transplant and reviews the management of immunosuppression related Kaposi's sarcoma.

Sleep disorders in Saudi health care workers.

BACKGROUND: The objective of the study was to screen for sleep habits and various sleep disorders, using a standard questionnaire. PATIENTS AND METHODS: The questionnaire was designed to assess sleep habits, the degree of daytime sleepiness using the Epworth Sleepiness Scale (ESS), and specific sleep problems. A random sample of Saudi employees working as medical or paramedical personnel was selected. RESULTS: There were 163 respondents (65%) comprising 33 females and 130 males. The mean ESS score was 9.4. Sixty-four respondents (39.3%) had an ESS score of more than 10, i.e., excessive daytime sleepiness (EDS). When subjects with poor sleep habits and/or sleep problems were excluded, there were 65 ânormalâ sleepers, with a mean ESS score of 8.9+/-3.6. This did not differ from the rest of the sample population, who had a score of 9.8+/-3.7 (P=0.15). Subjects with inadequate sleep or insomnia consisted of 17 females (51.5%) and 45 males (34.6%). There were seven subjects, all males (5.4%), with habitual snoring. Ten males (7.7%) and two females (6.1%) reported having breathing pauses while asleep. Symptoms of restless leg syndrome, sleep paralysis, and cataplexy were reported by 21 (12.9%), 26 (16.0%) and two (1.2%) subjects, respectively. CONCLUSION: The prevalence of EDS in the Saudi population is higher compared to that reported from other populations when a Western ESS normal range is used. Nevertheless, the range of normal score of ESS is probably broader for Saudis compared to other populations. In general, sleep disorders are common but unrecognized in our community.

The presence of atypical mycobacteria in the mouthwashes of normal subjects: role of tap water and oral hygiene.

BACKGROUND: The nontuberculous mycobacteria (NTM) have been found in different environmental sources. They tend to colonize different body surfaces and secretions. The purpose of this study is to evaluate the presence of NTM in the oral cavity of healthy individuals and its relationship to tap water or oral hygiene. MATERIALS AND METHODS: One hundred sixty-seven healthy subjects were recruited. Three consecutive early morning mouthwashes using tap water were performed and examined for the presence of Mycobacterium tuberculosis (MTB) and NTM. In addition we obtained mouthwashes from 30 control healthy individuals with good oral hygiene using sterile water and examined these for the presence of MTB and NTM. RESULTS: NTM was isolated from the mouthwash of 44 (26.3%) subjects that used tap water. On the other hand, NTM was isolated from the mouthwash of 10 (33%) subjects that used sterile water. Age, gender, social class oral hygiene and the regular use of toothbrush made no statistically significant differences in the isolation rate of NTM. CONCLUSION: The rate of isolation of NTM from mouthwash is high in normal subjects. It is independent of oral hygiene, the use of tap water or teeth brushing. Smear-positive sputum could be NTM rather than M. tuberculosis. Tuberculosis polymerase chain reaction or culture confirmation is essential in developing countries to avoid the unnecessary use of antituberculosis therapy when the clinical suspicion is very low.

Huntington's disease in a Sudanese family from Khartoum.

Typical Huntington's disease (HD) was studied in a 40-year-old Sudanese man from Khartoum. He had 51 CAG repeats in the Huntington's gene. It is suspected that his mother and his 16-year-old son (both deceased) were also affected. Up to now, there had only been anecdotal evidence of HD in the Sudanese.

Microtibial embolectomy.

BACKGROUND: microtibial embolectomy is an important technique in cases of limb threatening acute arterial occlusion affecting native crural and pedal vessels. It is particularly useful when thrombolysis is contraindicated or ineffective as in "trash foot". METHODS: in order to evaluate the efficacy of this technique, a retrospective case note review was carried out for patients undergoing microtibial embolectomy from 1990 to 1999. Data collected included the causes and degree of ischaemia, additional procedures required, vessel patency, limb salvage and complications encountered. RESULTS: twenty-two limbs underwent exploration of the crural/pedal vessels with ankle level arteriotomies under local anaesthetic in 12 cases, general anaesthetic in nine and epidural in one. The causes of ischaemia were cardiac emboli (8), "trash foot" (7), emboli from aortic and popliteal aneurysms (3) and thrombotic occlusion of crural vessels (4). The vessel patency rate was 69% and limb salvage rate 62% (13/21) up to 5-years follow-up. Six of the seven cases with "trash foot" were salvaged while one required an amputation at 3-months post-operatively. The 30-day mortality was 22% (5/22). CONCLUSIONS: microtibial embolectomy is effective in acute occlusion of the crural/pedal arteries including cases of "trash foot", offering limb salvage to a worthwhile proportion of cases.