Asunto(s)
Humanos , Femenino , Adolescente , Bazo/diagnóstico por imagen , Tuberculosis Esplénica/diagnóstico , Tuberculosis Esplénica/tratamiento farmacológico , Escleritis/diagnóstico , Hepatitis Autoinmune/tratamiento farmacológico , Enteritis/diagnóstico , Fiebre , Mycobacterium tuberculosis/aislamiento & purificación , Esplenectomía , Huésped Inmunocomprometido , Diagnóstico DiferencialAsunto(s)
Adalimumab/efectos adversos , Antirreumáticos/efectos adversos , Síndrome Inflamatorio de Reconstitución Inmune/inducido químicamente , Absceso Hepático/etiología , Tuberculosis Hepática/etiología , Tuberculosis Miliar/etiología , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adalimumab/uso terapéutico , Adulto , Antirreumáticos/uso terapéutico , Antituberculosos/uso terapéutico , Sustitución de Medicamentos , Quimioterapia Combinada , Femenino , Humanos , Síndrome Inflamatorio de Reconstitución Inmune/complicaciones , Huésped Inmunocomprometido , Tuberculosis Latente/complicaciones , Absceso Hepático/diagnóstico por imagen , Absceso Hepático/tratamiento farmacológico , Mesalamina/uso terapéutico , Proctocolitis/complicaciones , Proctocolitis/tratamiento farmacológico , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Ganglionar/complicaciones , Tuberculosis Ganglionar/tratamiento farmacológico , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Esplénica/diagnóstico por imagen , Tuberculosis Esplénica/tratamiento farmacológico , Tuberculosis Esplénica/etiologíaRESUMEN
A 65-year-old woman underwent FDG PET/CT for presumed hepatosplenic malignancy suggested by an abdominal CT. The images revealed multiple foci of intense FDG activity in both the liver and the spleen. However, a splenic biopsy result revealed no malignant cells, and either tuberculosis or sarcoidosis was proposed. Following an incomplete antituberculosis therapy, a repeat FDG PET/CT showed resolution of the abnormal activity in the liver and the spleen.
Asunto(s)
Tomografía Computarizada por Tomografía de Emisión de Positrones , Tuberculosis Hepática/diagnóstico por imagen , Tuberculosis Esplénica/diagnóstico por imagen , Anciano , Femenino , Fluorodesoxiglucosa F18 , Humanos , Radiofármacos , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Esplénica/tratamiento farmacológicoAsunto(s)
Absceso Abdominal/diagnóstico por imagen , Fiebre de Origen Desconocido/microbiología , Tuberculosis Esplénica/diagnóstico , Absceso Abdominal/microbiología , Femenino , Humanos , Persona de Mediana Edad , Tuberculosis Esplénica/complicaciones , Tuberculosis Esplénica/tratamiento farmacológicoRESUMEN
For many years, tuberculosis (TB) has been endemic in Pakistan; many rare and unusual presentations have been reported. There is a myriad of non-specific symptoms which always requires a high index of clinical suspicion for TB. World Health Organization data suggest that Pakistan ranks as the fifth highest country burdened with TB and has the fourth highest prevalence of multi-drug resistant TB globally. With an annual incidence of 277 cases per 100,000, the importance of early diagnosis and treatment is self-evident. We present a case where a strong suspicion of isolated hepatosplenic TB in an immunocompetent patient justified a directed approach.
Asunto(s)
Tuberculosis Hepática/diagnóstico , Tuberculosis Esplénica/diagnóstico , Adulto , Antituberculosos/uso terapéutico , Humanos , Huésped Inmunocomprometido , Masculino , Mycobacterium tuberculosis/aislamiento & purificación , Tomografía Computarizada por Rayos X , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Hepática/microbiología , Tuberculosis Esplénica/tratamiento farmacológico , Tuberculosis Esplénica/microbiologíaRESUMEN
BACKGROUND: Isolated tuberculosis of the spleen has been described occasionally in literature, mostly in immunosuppressed individuals with various risk factors. Sequestration in the spleen makes such Mycobacterium tuberculosis infection difficult to diagnose. This report describes an extremely rare case of isolated splenic tuberculosis in an immunocompetent individual. CASE PRESENTATION: A 26 year old Kenyan male presented with pyrexia of unknown origin, with negative screening tests for bacterial, fungal and parasitic infections. Ziehl-Neelsen staining and GeneXpert tests were negative for M. tuberculosis. Diagnosis of isolated splenic tuberculosis was made on core biopsy of the spleen. The patient initially worsened upon treatment with antituberculous medication attributable to the 'Paradoxical Reaction' phenomenon, before making full recovery. CONCLUSIONS: This case highlights the need to continuously be on the lookout for tuberculosis especially in unusual presentations, including subsequent paradoxical reaction which may be encountered.
Asunto(s)
Antituberculosos/uso terapéutico , Fiebre/diagnóstico por imagen , Bazo/diagnóstico por imagen , Tuberculosis Esplénica/diagnóstico por imagen , Adulto , Biopsia con Aguja Fina , Fiebre/tratamiento farmacológico , Fiebre/inmunología , Fiebre/microbiología , Humanos , Inmunocompetencia , Masculino , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/patogenicidad , Mycobacterium tuberculosis/fisiología , Bazo/microbiología , Bazo/patología , Bazo/cirugía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Tuberculosis Esplénica/tratamiento farmacológico , Tuberculosis Esplénica/inmunología , Tuberculosis Esplénica/microbiologíaRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Esplénica/complicaciones , Tuberculosis Esplénica/tratamiento farmacológico , Azatioprina/efectos adversos , Azatioprina/uso terapéutico , Esplenectomía/métodos , Antituberculosos/uso terapéutico , Arteria Esplénica , Arteria Esplénica/lesiones , Laceraciones/inducido químicamente , Laceraciones/complicaciones , Laceraciones/tratamiento farmacológico , Laparotomía/métodos , Mycobacterium tuberculosis , Mycobacterium tuberculosis/aislamiento & purificaciónRESUMEN
We report a case of a 61-year-old man who presented with a cough and abdominal discomfort. CT scan of the chest showed two lesions across both lungs, and an abdominal CT scan revealed multiple hypodense lesions in the spleen with cystic lesions on the splenic hilum. Upper gastrointestinal tract endoscopy found creamy yellowish discharge through a fistula between the stomach and splenic hilum. Under fluoroscopic guidance, forceps was inserted into the fistula tract, and forcep biopsy was done. The pathology was consistent with tuberculosis, and a nine-month anti-tuberculosis medication regimen was started. Imaging performed three months after finishing medication indicated improvement of splenic lesions, and the gastro-splenic tract was sealed off. This case is a very rare clinical example of secondary splenic tuberculosis with a gastro-splenic fistula formation in an immunocompetent patient.
Asunto(s)
Enfermedades del Bazo/diagnóstico , Tuberculosis Esplénica/diagnóstico , Antituberculosos/uso terapéutico , Fluoroscopía , Fístula Gástrica/patología , Gastroscopía , Humanos , Masculino , Persona de Mediana Edad , Bazo/diagnóstico por imagen , Bazo/patología , Enfermedades del Bazo/diagnóstico por imagen , Enfermedades del Bazo/patología , Tomografía Computarizada por Rayos X , Tuberculosis Esplénica/tratamiento farmacológico , Tuberculosis Esplénica/microbiología , UltrasonografíaRESUMEN
Tuberculosis caused by Mycobacterium tuberculosis presents a major health challenge in endemic countries and spares no organ in the human body. This infection is a mimicker of various disease processes such as metastasis, lymphoproliferative diseases, and other granulomatous conditions such as sarcoidosis and fungal infections. The most challenging and important differential is metastasis, especially in the disseminated form of tuberculosis. We present a histopathologically proven case of isolated hepatosplenic tuberculosis that was provisionally diagnosed as lymphoma due to its unusual, restricted involvement of the liver and spleen.
Asunto(s)
Dolor Abdominal/etiología , Antituberculosos/administración & dosificación , Tomografía Computarizada por Rayos X , Tuberculosis Hepática/diagnóstico , Tuberculosis Esplénica/diagnóstico , Diagnóstico Diferencial , Etambutol/administración & dosificación , Femenino , Humanos , Isoniazida/administración & dosificación , Persona de Mediana Edad , Pirazinamida/administración & dosificación , Rifampin/administración & dosificación , Resultado del Tratamiento , Tuberculosis Hepática/complicaciones , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Esplénica/complicaciones , Tuberculosis Esplénica/tratamiento farmacológico , Pérdida de PesoRESUMEN
Effective global tuberculosis control is hindered by the need for prolonged chemotherapy which leads to poor patient compliance. Therefore novel drug targets that shorten the duration of chemotherapy and reduce disease relapse rates are highly desirable. We have previously shown that HspX, an alpha-crystallin-like protein, is associated with growth suppression of Mycobacterium tuberculosis in mouse models. We determined to evaluate hspX as a novel target for controlling M. tuberculosis growth in combination with traditional antibiotic therapy in the Cornell mouse model. The hspX deletion mutant (ΔhspX) was used as a model of potential hspX inhibition. Normal BALB/c mice were infected with ΔhspX or the wild type (WT) strain. Three weeks after infection, the mice were treated with rifampicin, isoniazid and pyrazinamide for 14 weeks followed by 8 weeks of hydrocortisone. The effect of chemotherapy was measured by organ bacterial counts and the relapse rate. Antibiotic treatment of mice infected with ΔhspX resulted in faster visceral clearance; organs were disease free 8 weeks post-treatment for ΔhspX infection compared to 14 weeks for the WT strain. Disease relapse rate was significantly lower in ΔhspX infection (60.7%) compared to WT infection (92.6%). HspX may be a promising therapeutic target in combination with traditional antibiotic therapy to shorten the length of treatment and reduce disease relapse.
Asunto(s)
Antibacterianos/farmacología , Proteínas Bacterianas/antagonistas & inhibidores , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Esplénica/tratamiento farmacológico , Animales , Antiinflamatorios/farmacología , Antígenos Bacterianos/genética , Proteínas Bacterianas/genética , Células Cultivadas , Modelos Animales de Enfermedad , Quimioterapia Combinada , Femenino , Técnicas de Inactivación de Genes , Hidrocortisona/análogos & derivados , Hidrocortisona/farmacología , Inmunosupresores/farmacología , Ratones Endogámicos BALB C , Mutación/genética , Mycobacterium tuberculosis/genética , RecurrenciaAsunto(s)
Absceso/complicaciones , Absceso/diagnóstico por imagen , Rotura del Bazo/diagnóstico por imagen , Rotura del Bazo/etiología , Tuberculosis Esplénica/complicaciones , Tuberculosis Esplénica/diagnóstico por imagen , Absceso/cirugía , Antituberculosos/uso terapéutico , Diagnóstico Diferencial , Drenaje/métodos , Humanos , Masculino , Persona de Mediana Edad , Rotura Espontánea , Bazo/diagnóstico por imagen , Bazo/cirugía , Esplenectomía/métodos , Rotura del Bazo/cirugía , Tomografía Computarizada por Rayos X/métodos , Tuberculosis Esplénica/tratamiento farmacológicoRESUMEN
The potential of (18)F-FDG PET/CT in the diagnosis and treatment response monitoring of fever of unknown origin (resulting from hepatosplenic tuberculosis) is demonstrated in this report. The patient was a 32-y-old woman who had presented to us with a history of pyrexia of unknown origin for the past 2 mo. On investigation, she was found to have hepatic and splenic granulomas, with whole-body (18)F-FDG PET demonstrating abnormal (18)F-FDG-avid foci in the liver and spleen. Ultrasonography-guided liver biopsy was suggestive of granulomatous hepatitis. The patient was clinically nonresponsive to first-line antitubercular drugs, and second-line antitubercular medications were added subsequently in view of clinical nonresponse. The patient responded well to the treatment. The repeated CT scan at 11 mo demonstrated persistence of the splenic granulomas; however, follow-up (18)F-FDG PET/CT at the same time showed resolution of (18)F-FDG-concentrating active disease foci with suggestion of complete metabolic response, commensurate with the patient's clinical improvement.
Asunto(s)
Fiebre/diagnóstico , Fluorodesoxiglucosa F18 , Imagen Multimodal/métodos , Tomografía de Emisión de Positrones/métodos , Tomografía Computarizada por Rayos X/métodos , Tuberculosis/diagnóstico , Adulto , Antituberculosos/uso terapéutico , Diagnóstico Diferencial , Femenino , Fiebre/complicaciones , Fiebre/tratamiento farmacológico , Estudios de Seguimiento , Humanos , Hígado/diagnóstico por imagen , Radiofármacos , Bazo/diagnóstico por imagen , Resultado del Tratamiento , Tuberculosis/complicaciones , Tuberculosis/tratamiento farmacológico , Tuberculosis Hepática/complicaciones , Tuberculosis Hepática/diagnóstico , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Esplénica/complicaciones , Tuberculosis Esplénica/diagnóstico , Tuberculosis Esplénica/tratamiento farmacológico , Imagen de Cuerpo Entero/métodosRESUMEN
Pulmonary tuberculosis is very devastating in developing countries and its thrombogenic potential is a disturbing new entity. We report an 18-year-old woman who presented with a first episode of deep vein thrombosis. Pulmonary, hepatic and splenic tuberculosis was diagnosed while looking for secondary causes. The patient was treated with rifampicin, isoniazid, pyrazinamide and ethambutol along with low-molecular-weight heparin and antivitamin K. Tuberculosis has several mechanisms that induce a hypercoagulable state and can lead to thromboembolic complications.
Asunto(s)
Tuberculosis Hepática/complicaciones , Tuberculosis Pulmonar/complicaciones , Tuberculosis Esplénica/complicaciones , Trombosis de la Vena/complicaciones , Adolescente , Anticoagulantes/uso terapéutico , Antituberculosos/uso terapéutico , Femenino , Humanos , Trombofilia/sangre , Trombofilia/tratamiento farmacológico , Tuberculosis Hepática/sangre , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Pulmonar/sangre , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Esplénica/sangre , Tuberculosis Esplénica/tratamiento farmacológico , Trombosis de la Vena/sangre , Trombosis de la Vena/tratamiento farmacológicoAsunto(s)
Enfermedades Raras/diagnóstico , Tuberculosis Esplénica/diagnóstico , Antituberculosos/uso terapéutico , Diabetes Mellitus Tipo 2/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Raras/tratamiento farmacológico , Tuberculosis Esplénica/tratamiento farmacológicoRESUMEN
Fever of undetermined origin always poses a challenging problem to the physician. Tuberculosis is an important health problem in developing countries. It is mostly seen in immune-compromised patients. And it is one of the common causes of fever of unknown origin. I am reporting a case of a splenic tuberculosis in 48 years old male who is not known of any immune deficiency state, he was presented with 3 weeks history of fever and found to have severe neutropenia and with negative work up for all hematological, rheumatological and malignant causes. A computerized tomography scan of the abdomen confirmed splenic enlargement with multiples hypo dense lesions consist with either splenic infection or splenic lymphoma so exploratory splenectomy was performed. Histological examination revealed granulomatouse inflammation with numerous acid fast bacilli consist with tuberculosis. He was started on four anti-tuberculouse drugs. in less than one week his fever subside with normalization of his neutrophilic count.