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[Acute pancreatitis complicated by a tubercular abscess].
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Suspect more adrenocortical insufficiencies.
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[Tuberculosis of the pancreas in a HIV-seropositive patient].
A 34-year-old man from Nigeria who had resided permanently in the Netherlands for five years had experienced fever, upper abdominal pain and weight loss for several months. He did not give the impression of being ill. A CT scan gave cause to suspect pancreatitis. An HIV test gave a positive result. Puncture of the accumulated fluid around the pancreas led to the diagnosis 'tuberculosis' (infection by Mycobacterium tuberculosis). Once the patient had made a good recovery with antituberculosis therapy, antiretroviral therapy was initiated, whereupon the number of CD4+ cells in the blood increased. Extrapulmonal tuberculosis is not unusual in HIV seropositive patients from countries with a high prevalence of tuberculosis. However, in such patients isolated tuberculosis of the pancreas is unusual and has not previously been described in the Netherlands. The diagnosis can be established following a CT guided puncture; tuberculosis is instantly suspected if the Ziehl-Neelsen stains are positive and the diagnosis can then be confirmed by a polymerase chain reaction (PCR) analysis and by culturing. Anti-retroviral therapy is withheld until response to anti-tuberculosis treatment is satisfactory.
[Thyroid tuberculosis associated with papillary microcarcinoma of the thyroid gland: a case report].
Tuberculosis of the thyroid gland is extremely uncommon. The infection may present first in the thyroid gland or appear secondary to a tuberculous process elsewhere in the body. The diagnosis is rarely made clinically because the different presentations of the disease often mimick malignancy or euthyroid nodular goitre. It is of interest to report a case of tuberculosis of the thyroid associated with papillary microcarcinoma of the gland. No tuberculous process elsewhere in the body has been found. The frequency of MCP on thyroidectomy specimens suggest that this association is incidental.
Tuberculosis of the thyroid: two case reports.
Tuberculosis of the thyroid gland occurs only rarely. Since extrapulmonary tuberculosis is now seen relatively more frequently the existence of this condition should be recognized. The cases of two patients with tuberculosis involving the thyroid are presented. The first, an Asian immigrant, presented with a painless goitre with no evidence of tuberculosis elsewhere. The second was an English woman who presented with hypothyroidism due to destruction of the thyroid by tuberculosis, and who subsequently died with disseminated tuberculosis; this is the only case to report the association between myxoedema and tuberculous thyroiditis. Other manifestations of thyroid tuberculosis and the pathological types are discussed.
Suppurative neck abscess due to tuberculous thyroiditis.
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[Adrenal tuberculous pseudotumour].
Tuberculous pseudotumour of the adrenal gland with no other extra-adrenal sites of tuberculosis is a very rare entity. The authors describe the case of a 24-year-old patient in whom ultrasound and CT revealed a right adrenal mass. Adrenalectomy was performed by laparoscopy and the aetiological diagnosis was only established after histological examination of the operative specimen.
[Forensic medical identification of sudden death due to tuberculosis of adrenal glands].
Two cases died of tuberculosis of adrenal glands were reported. The pathological findings are presented and their medico-legal significance was also discussed. In particular, emphasis is placed on the importance of histopathologic examination of the adrenal glands in the tuberculous subjects dying suddenly and in whom no obvious cause of death was found at necropsy.
[Non-tuberculous Addison's disease: report of a case caused by syphilitic gumma, another one by metastatic bronchial carcinoma and two other by atrophy].
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[Role of the endocrine system in pathogenesis of tuberculosis with special reference to the adreno-pituitary system].
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Thyroid tuberculosis.
The aim of this article is to collect and to review reference data about thyroid tuberculosis from all-over the world and to analyze urgency and changeability of this problem since 19th century until now. Data show that there are cases of thyroid tuberculosis still occurring in many countries of the world, including highly developed countries. It turned out that the disease can manifest in various ways and that it does not have specific symptoms characteristic only to thyroid tuberculosis. The main method for establishing diagnosis is fine-needle aspiration with subsequent bacterioscopical, bacteriological or biological investigation. Still, for verification of diagnosis, ultrasonography, even computerized tomography and the newest serological diagnostic methods of tuberculosis may be necessary. In conclusion, thyroid tuberculosis should be differentiated from other diseases of thyroid: various types of thyroiditis, Graves disease and nodular goiter. It is particularly vital to distinguish thyroid tuberculosis from thyroid cancer, in attempt to avoid unnecessary thyroid surgery. While treating thyroid tuberculosis, there is a choice of thyroid surgery, antituberculous drugs and repeated puncture drainage procedures. Sometimes these methods can be combined.
A thyroid tubercular abscess and bilateral symmetrical hilar lymphadenopathy: a rare association.
An 18-year-old boy presented with a rare association of a thyroid tubercular abscess and bilateral symmetrical hilar lymphadenopathy. He was put on a Category I regimen with standard short course daily chemotherapy of four anti-tubercular drugs under the National Tuberculosis Programme. After a six-month of anti-tubercular treatment (ATT), the boy showed clinical and bacteriological improvement. The thyroid scan with Technetium 99 (Tc 99) and the chest skiagram also became normal.
[Addison's diseases caused by adrenal tuberculosis--case report].
A case of adrenal tuberculosis with acute Addison's disease is described. The disease manifested acute as suprarenal crisis. Metastatic and autoimmunological (antisuprarenal antibodies were not found) etiology was excluded. Computed tomography demonstrated calcifications in both, enlarged adrenals. After antituberculosis treatment and corticosteroid therapy we observed significant improvement in our patient's condition.
[Bilateral adrenal tumoral formation. Regressive spontaneous evolution].
A case of bilateral adrenal tumoral formation associated with Addison's disease is reported, and the possible cause of this association is discussed. The short-term deleterious course of metastatic malignancies, hemopathies or severe infections when left without specific treatment, and the long-term course of our patient's tumoral pathology excluded these diagnoses. The spontaneous regression of a bilateral pseudotumoral mass was suggestive of 2 causes: haematoma or tuberculosis. Haematoma was unlikely in the absence of causal factors, and this, combined with the slow regression of the adrenals, made tuberculosis the most probable diagnosis. The few similar cases found in the literature are reviewed.
[Thyroiditis of probable tubercular etiology and the recurrence of Graves-Basedow disease].
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[A Somali man with a painful thyroid mass: thyroid tuberculosis].
A 21-year-old man from Somalia presented with a painful mass in the thyroid, 6 months offatigue, weight loss and fever. Two separate courses of antibiotics did not improve his condition. Thyroid function tests were normal. The chest X-ray showed an enlarged hilus with some pulmonary infiltration around it. The diagnosis ofthyroid tuberculosis was established by cytological, microbiological and PCR testing of a fine needle aspirate of a thyroid lymph node. Treatment with antituberculosis agents resulted in a complete clinical response. The differential diagnosis of a painful thyroid mass encompasses subacute granulomatous thyroiditis, infectious thyroiditis, radiation- or trauma-induced thyroiditis and haemorrhage in the thyroid lymph nodes. Although thyroid tuberculosis is mainly a disease of developing countries, increasing immigration can lead to a higher incidence of this rare form of extrapulmonary tuberculosis and should therefore also be considered in patients with a painful thyroid mass.