Chest Infections |

Mycobacterium Tuberculosis: A Continous Challenge for Physicians FREE TO VIEW

Paloma Manea, MD; Madalina Bodescu, MD; Mirela Grigorovici, MD; Mihaela Archip, MD; Cristian Badescu, MD; Rodica Ghiuru, MD
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University of Medicine and Pharmacy “Gr.T.Popa”, Iasi, Romania, Iasi, Romania

Chest. 2014;145(3_MeetingAbstracts):98A. doi:10.1378/chest.1835500
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SESSION TITLE: Tuberculosis Case Report Posters

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Comorbidities could become pitfalls for a correct diagnosis. Physical signs may suggest an active disease, if appropiate investigations are not effectuated.

CASE PRESENTATION: A 50 years old male patient was diagnosed (2011) with ankylosing spondylitis by the rheumatologist (sacroiliitis,specific modifications of the vertebral bodies, anterior uveitis and HLA-B27 positive).He had a 7.1 BASDAI score(Bath Ankylosing Spondylitis Disease Activity Index) and he received Sulfasalazine 2g/day,without significant improvement.He remarked fever,sweating and decreased appetite, since July 2013.Physical examination specified a left submandibular tumour 10/10 mm, with fistula.Montaux tuberculin skin test was positive: 25 mm(blister); Quanti-FERON-TB Gold test was also positive: above 10IU/ml-negative values: bellow 0.35; echocardiography revealed fibrous pericarditis (7mm pericardial thickening); computed thoracic tomography indicated left anterior phrenicocostal sinus pleura thickening:10 mm and perihilar calcified pulmonary nodules.As a first diagnosis (at this step) for this submandibular tumour with fistula we thought at active lymph node tuberculosis.The surprise was the morphopathological diagnosis of the tumour:lymphoepithelial cyst with fistula.The cultures from sputum, urine and pustula'pus were all negative for Mycobacterium tuberculosis.The pneumologist considered a recent (bellow 2 years) Mycobacterium tuberculosis infection (but not active) and recommended a delay of treatment with Tumour-Necrosis-Factor alpha blockers, indicated for spondylitis,with revaluation after 6 months.

DISCUSSION: Our case proved the fact that first clinical thought could not be the appropiate diagnosis,without strong evidences.

CONCLUSIONS: Only interdisciplinary work could nowadays alllow a correct diagnosis.

Reference #1: Nahid P., Pai M, Hopewell P.C.,Advances in the diagnosis and treatment of tubrculosis,Proc Amer Thoracic Soc 3:103-110

Reference #2: Kim E.M.,Uhm W.,Bae S.C.,Yoo D.H.,Kim T.H.,Incidence of tuberculosis among korean patients with Ankylosing spondylitis who are taking tumor necrosis factor blockers,J Rheumatol 2011Oct;38(10):2218-23

DISCLOSURE: The following authors have nothing to disclose: Paloma Manea, Madalina Bodescu, Mirela Grigorovici, Mihaela Archip, Cristian Badescu, Rodica Ghiuru

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