The triad of weight loss, fever and night sweating: isolated bone marrow tuberculosis, a case report.

Extrapulmonary tuberculosis is known to be the infection in an organ with or without pulmonary involvement. The infection in extrapulmonary tuberculosis is insidious and the symptoms and signs are generally nonspecific. We describe a 56-year-old male patient complaining of weight loss, fever, and night sweats. Although there were no signs and symptoms attributable to pulmonary tuberculosis, polymerase chain reaction (PCR), microscobical and cultural examination of bone marrow aspirate revealed isolated bone marrow tuberculosis. A treatment protocol of isoniazid, rifampicin, pyrazinamide, and streptomycin was administered. After 9 months of treatment, re-examination of the bone marrow revealed no signs of tuberculosis. Tuberculosis should be kept in mind especially in endemic areas and bone marrow should be examined in case of suspected tuberculosis infection.

Serum and ascites fluid cytokine levels in patients with chronic heart failure.

OBJECTIVE: Cytokines that are capable of modulating cardiovascular function were reported to be elevated in patients with advanced heart failure. We evaluated the diagnostic importance of cytokines both in the serum and ascites. MATERIAL AND METHODS: We determined serum and ascites fluid TNF-alpha, IL-1beta, IL-6, IL-8, and soluble IL-2 receptor levels in 14 patients with congestive heart failure (group 1) and in 15 patients with chronic liver disease (group 2). RESULTS: Ascites fluid IL-8 and soluble IL-2 receptor levels were found to be significantly elevated in group 1 when compared with group 2 (p = 0.014 and p = 0.005). There were no statistical differences in serum TNF-alpha, IL-1beta, IL-6, IL-8, and soluble IL-2 receptor levels and ascites fluid TNF-alpha, IL-1beta, and IL-6 levels. Ascites fluid/serum IL-1beta and IL-8 ratio was lower in group 1 when compared with group 2 (p = 0.001 and p = 0.005). Ascites fluid/serum IL-2 and IL-6 ratio was higher in group 1 when compared with group 2 (p = 0.035 and p = 0.025). CONCLUSION: Cytokine levels in ascites fluid, but not in serum, are important in congestive heart failure. Ascites fluid/serum cytokine level ratios were detected to be more conclusive and valid in the diagnosis work-up of ascites aetiology.

The importance of serum and ascites fluid alpha-fetoprotein, carcinoembryonic antigen, CA 19-9, and CA 15-3 levels in differential diagnosis of ascites etiology.

BACKGROUND/AIMS: Clinical usage of tumor markers is being limited due to low specificity. Elevated plasma levels of tumor markers may be seen in diseases other than malignancy, i.e., kidney, liver or circulatory disturbances. METHODOLOGY: In our study, we studied serum and ascites fluid alpha-fetoprotein, carcinoembryonic antigen, CA 19-9, CA 15-3 levels in patients with chronic liver disease, spontaneous bacterial peritonitis, malignancy, tuberculous and congestive heart failure in a total of 76 patients. RESULTS: The sensitivity and specificity for ascites fluid alpha-fetoprotein levels were 28.5% and 100%, for serum alpha-fetoprotein levels 28.5% and 98.1%, for ascites fluid carcinoembryonic antigen levels 38.0% and 98.1%, for serum carcinoembryonic antigen levels 57.1% and 90.0%, for ascites fluid CA 19-9 levels 19.0% and 94.5%, for serum CA 19-9 levels 33.3% and 21.8%, for ascites fluid CA 15-3 levels 28.5% and 92.7%, and for serum CA 15-3 levels 47.6% and 81.8%, respectively. CONCLUSIONS: In conclusion, the sensitivity of serum and ascites fluid tumor markers was found to be low. High specificity may be due to low number of study participants. Serum and ascites fluid tumor markers are not found to be useful in the differential diagnosis of ascites etiology.