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PubMed1984

[A case of tuberculous myocarditis and rupture of a dissecting aortic aneurysm and of the left coronary artery of the heart during surgery for an aortic heart defect].

A rare case of tuberculous myocarditis, miliary type, in hematogenic-disseminated tuberculosis of lungs and liver is reported. Some morphological characteristics of tubercules in myocardium require a broad differential diagnosis with idiopathic granulomatous myocarditis, sarcoidosis, lues and brucellosis. Tuberculosis was in combination with isolated heart defect-- insufficiancy of aortic valve, hypertonic disease, atherosclerosis, dissecting aneurysm of ascending aorta and left coronary artery of the heart, complicated by a rupture during the cardiac operation.

Adult↗
PubMed1982

[Inflammatory lesions of the aorta and its branches, Introduction and etiological aspects (excluding Takayasu's disease)(author's transl)].

Acquired lesions of the aorta are not confined to atherosclerosis alone, and diagnostic, etiological, pathogenic, and therapeutic problems may be raised when confronted with less frequent infective or inflammatory processes. Syphilitic aortitis was for a long time considered to be the only infective lesion involving the aorta, but bacterial (mycotic) aneurysms were now known to exist. Many pathogenic agents may be involved: staphylococcus, Salmonella, pneumococcus, Proteus, Klebsiella, Brucella, more rarely KB, Rickettsia, or nematodes. Inflammatory causes have been recognized more recently, epidemiological and histological studies confirming their presence and the multiple etiologies involved: Horton's disease, rheumatic disorders, connective tissue diseases.

Aneurysm, Infected↗
PubMed1982

[Lesion of the cardiac arteries in general miliary tuberculosis].

An exceptionally rare case of isolated involvement of myocardial vessels with tuberculosis without the development of myocarditis is described. Tuberculosis granulomas were located in the adventitium of intra- and extramural ramifications of coronary vessels and along the fibers of interstitial tissue in immediate proximity to the vessels. The media was also affected in some areas by the specific inflammatory process in the form of foci. Uneven proliferation leading to the narrowing of the vessel lumina was observed in the intima. Tuberculous granulomas were found in the adventitium of the descending branch of the left coronary artery. The extention of the tuberculosis process into coronary vessels occurs most likely by the hematogenous route.

Aged↗
PubMed1982

Tuberculous pericarditis developing during chemotherapy.

A 6-year-old boy with active tuberculosis developed a pericarditis 9 weeks after starting adequate chemotherapy. Although no Mycobacterium tuberculosis was isolated from the pericardial fluid we assume, for several reasons, that the pericarditis was caused by tuberculosis. Consequently, it is important to be aware of possible serious complications even during treatment with adequate antituberculous drugs.

Child↗
PubMed1980

Vascular lesions in tuberculosis.

4 cases of tuberculosis in which the vessels were involved are described: 1 of tuberculous adenitis and arteritis in the region of the carotid artery bifurcation; 1 of tuberculous endometritis associated with aortic pseudoaneurysms and inferior vena cava partial occlusion, and 2 of tuberculous para-aortic adenitis, 1 with complete occlusion of the inferior vena cava, and the other with miliary nodulations of the liver later demonstrated by angiogram. It is suggested that in veiw of the ubiquitous presentations and incidence of tuberculosis in this environment, more vascular studies need be done to demonstrate the frequency and the involvement of the vessels by tuberculosis in cases of tuberculosis. Furthermore, in cases of aortitis and arteritis, tuberculosis must be excluded as an etiological cause.

Adult↗
PubMed1980

Late generalized tuberculosis: a clinical pathologic analysis and comparison of 100 cases in the preantibiotic and antibiotic eras.

1. The clinical and pathologic findings in 100 patients with late generalized tuberculosis (LGT) are described and a comparison made between the findings occurring in the preantibiotic era with those in the early antibiotic period. The clinical presentation of LGT as seen in a general hospital has changed. Whereas, in the preantibiotic era, LGT was often the primary disease, occurring principally in young adults and frequently associated with pulmonary symptoms, in the antibiotic era, LGT commonly occurred together with and was frequently obscured by other diseases, often afflicted the elderly and was much less frequently accompanied by pulmonary symptoms. Symptoms related to extrapulmonary organ tuberculosis in this era were absent in 30% of patients. 2. Diagnostic difficulties in LGT arose because 20% of patients exhibited no constitutional symptoms prior to hospitalization, a history of tuberculosis often was lacking, fever curves and hematologic findings, with the exception of a left shift, commonly were non-specific, monocytosis frequently was absent, chest x-rays were non-diagnostic in about 50% of the cases, and anergy occured particularly in the elderly. 3. Caseous foci responsible for hematogenous spread generally derived from reactivated old caseous lesions located principally in the lungs, lymph nodes, bone, central nervous system, adrenals, and genito-urinary tract. Simultaneous reactivation of anatomically unrelated foci in multiple organs and lymph nodes occurred in 54% of cases. Although chronic pulmonary tuberculosis commonly was associated with LGT in the preantibiotic era, this association was uncommon in recent times. Chronic pulmonary tuberculosis served as the sole source for hematogenous dissemination infrequently and the pulmonary lesions responsible were acute. 5. Large caseous foci located in lymph nodes, bone, prostate gland, and central nervous system frequently occurred in the absence of clinical symptoms and therefore were undiagnosable. 6. The clinical course of LGT was often rapid, although histologic features indicated that the course in some patients was protracted or even episodic. 7. Miliary tubercles very frequently showed caseation and often they enlarged to cause progressive or complicated lesions. Chest x-rays and culture diagnoses were dependent on the formation of these complicated lesions. 8. Liver biopsy is recommended as a diagnostic procedure since 97% of patients exhibited granulomata in this organ. Of diagnostic importance is the fact that 90% of these granulomata exhibited caseous necrosis. Twenty-two percent of patients with liver granulomatas did not show tubercles in the bone marrow. 9. Multiple pathways rather than an exlcusive lymphangitic route were available for tubercle bacilli to gain access to the blood stream and cause hematogenous dissemination.

Adolescent↗
PubMed1994

Papulonecrotic tuberculid. A clinical, histopathological, and immunohistochemical study of 15 patients.

We report 10 women and five men with papulonecrotic tuberculid, an uncommon form of cutaneous tuberculosis (TB). The mean age was 22.6 years (range, 2 1/2-35 years) at presentation. The Mantoux test was strongly positive in 13 patients. Five patients showed presumptive evidence of associated TB; in one case, the presence of TB was proven by culture. Response to anti-TB was dramatic in all cases. Clinical findings were similar to those previously published. We emphasize the simultaneous occurrence of erythema induratum, associated Takayasu's disease, possible associated phlebitic tuberculid, and clinical mimicry of acute bacterial endocarditis. The main histopathological findings obtained from 27 biopsy specimens included dermal necrosis (26 of 27 cases), a poorly formed granulomatous infiltrate (27 of 27 cases), vasculitis (11 of 27 cases), perivascular spongy edema (11 of 27 cases), and follicular necrosis or suppuration (five of 27 cases). A Ziehl-Neelsen stain was negative in all biopsy specimens. Immunohistochemical labeling revealed a preponderance of T-lymphocytes (UCHL-1+), monocytes-macrophages (S-100+), and Langerhans cells (ACT+), indicative of a type IV hypersensitivity reaction. B-lymphocytes (L26+) were sparse. Conditions that may be confused with PNT on clinical or histopathological ground include pityriasis lichenoides et varioliformis acuta, papular urticaria, papulopustular syphilide, miliary TB, septicemia, perforating granuloma annulare, chondrodermatitis nodularis, reactive perforating collagenosis, allergic granulomatosis, suppurative folliculitis, and infectious causes of palisading granulomas. Papulonecrotic tuberculid has distinct clinical, histopathological, and immunohistochemical features. Awareness of this entity is important since an appropriate diagnosis is necessary for the institution of timely curative treatment.

Adolescent↗
PubMed1993

[Case report of miliary TB, with mediastinal TB involving the aorta, trachea and esophagus with death due to hemorrhage from perforation of aorta into the esophagus during treatment].

A 32-year-old male was diagnosed as having miliary tuberculosis in May 1990. In spite of antituberculosis chemotherapy, he developed tuberculous meningitis and intracranial tuberculoma in September 1990. Miliary shadows on chest X-ray disappeared in December 1990. However, he developed left atelectasis, and bronchofiberscopy revealed soft tumor in the left main bronchus in January 1991. He suddenly vomited large amounts of blood and expired in February 1991. At autopsy, tuberculous lymphadenitis and cavitation were noted in the mediastinum, through which the left main bronchus, esophagus and descending aorta communicated. The patient died of massive bleeding which resulted from the rupture of tuberculous aortitis into the esophagus. This is a very rare case of tuberculous aortic aneurysm rupturing into both the bronchus and esophagus.

Adult↗
PubMed1993

The impact of human immunodeficiency virus on presentation and diagnosis of tuberculosis in a cohort study in Zambia.

Two hundred and forty-nine patients with tuberculosis were recruited to a cohort study to investigate the interaction between tuberculosis and HIV in Lusaka, Zambia; findings at presentation are presented here. One hundred and eighty-two (73%; 95% confidence interval 67-79%) of the cases were HIV-1 antibody positive. The diagnosis of tuberculosis was confirmed by microscopy for acid-alcohol fast bacilli, culture of Mycobacterium tuberculosis, or histology in 74% of all cases. HIV negative and positive cases differed in site of disease: among HIV negative patients 72% had pulmonary disease alone, 16% extrapulmonary disease alone and 12% had both, whereas among HIV positive patients 40% had pulmonary disease alone, 34% extrapulmonary disease alone and 26% both (P < 0.001). HIV negative and positive cases were compared with regard to outcome of diagnostic procedures: 55% of HIV negative cases could be diagnosed at enrollment by sputum smear, but only 35% of HIV positive cases (P < 0.01). Among pulmonary cases confirmed by sputum culture, 76% of HIV negative patients had a positive sputum smear, compared with 57% of HIV positive patients (P = 0.09). Pleural and pericardial disease were difficult to confirm, but culture of pleural fluid was positive in 12/46 HIV positive patients, compared with 0/11 HIV negative patients. Lymph node disease was readily confirmed by biopsy. The tuberculin test was positive in only 30/110 (27%) of HIV positive cases, but in 21/38 (55%) of HIV negative cases (P < 0.01). Mycobacterium tuberculosis was cultured in 57% of HIV negative cases and 54% of HIV positive cases; no atypical mycobacteria were isolated. Initial resistance to isoniazid was present in isolates from 5% of cases with a positive culture.

Adolescent↗
PubMed1997

[Manifestations and diagnosis of extrapulmonary tuberculosis].

Extra pulmonary tuberculosis currently represents 25 per cent of notified tuberculosis in France. All organs can be involved but the most frequent localisation are the lymph nodes. Immunodepressed patients notably those infected with HIV are particularly prone to a polyvisceral tuberculous infection. The diagnosis is often difficult on account of the polymorphism of the disease and the weak specificity of the clinical manifestation. A firm diagnosis always rests on histological or microbiological evidence. Certain recent developments should enable a more rapid microbiological diagnosis notably as a result of development in molecular biology and rapid culture techniques. The mortality and morbidity remain elevated in developing counties as in industrialised counties and clinical situations in which extra pulmonary tuberculosis occur often worsen the prognosis.

Bacteriological Techniques↗
PubMed1998

[A successfully treated case of miliary tuberculosis with adult respiratory distress syndrome and tuberculous aneurysm of abdominal aorta].

A 52-year-old woman visited a physician on Oct. 17, 1995 because of dizziness, general fatigue and a slight fever. A Chest X-ray film showed micronodulous and infiltrative shadows in the bilateral upper lung fields. Liver dysfunction was also recognized. As dyspnea and hypoxemia progressed very rapidly, the patient was intubated and kept under mechanical ventilation. A diagnosis of miliary tuberculosis with adult respiratory distress syndrome (ARDS) was made based on the detection of acid-fast bacilli from sputum obtained from the endotracheal tube. She was admitted to our hospital on Oct. 24, 1995 receiving anti-tuberculous drugs combined with high-dose methylprednisolone. As disseminated intravascular coagulation (DIC) and acute pancreatitis also developed, gabexate mesilate was added to the preceding therapy. This combination therapy was effective and the patient gradually improved. Two months after the admission, aneurysms of the abdominal aorta and left renal artery were discovered. As the size of the aneurysms had been increasing along with abdominal and low back pain, the patient was transferred to an other hospital for surgical treatment. She underwent a successful operation for pseudoaneurysms, the etiology of which was tuberculosis according to pathological findings and detection of acid-fast bacilli from the resected specimens. This is the 10th case of tuberculous aneurysm of the aorta which was successfully operated on in Japan. ARDS, DIC and aneurysm occur rarely as complications of miliary tuberculosis, but they are life-threatening, and lead to a serious prognosis if untreated. Early diagnosis of miliary tuberculosis and tuberculous aneurysm is very important for a good outcome.

Aneurysm, False↗