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A case of abdominal tuberculous lymphadenitis diagnosed by percutaneous needle biopsy under ultrasound control and followed up by ultrasound imaging was reported. A 63 years-old male was admitted to a certain hospital complaining of dizziness and diplopia. Chest roentgenogram showed bilateral infiltrative shadows in the upper lung fields and Mycobacterium tuberculosis was detected in cultures from specimens of gastric aspiration. Abdominal ultrasound examination and computed tomography showed abdominal lymph nodes swelling. Needle biopsy under ultrasound control was performed, and the specimens showed necrosis and Mycobacterium tuberculosis was positive by culture. He was diagnosed as lung tuberculosis with abdominal tuberculous lymphadenitis and admitted to our hospital for anti-tuberculous chemotherapy. Ultrasound examination done every two weeks showed diminution in size of the lymph nodes after a month of anti-tuberculous therapy. For the diagnosis of abdominal lymph node swelling, a needle biopsy under ultrasound control is safe and useful technique, and a ultrasound examination is also valuable to follow up the course of abdominal tuberculous lymphadenitis.
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PMID:[A case of abdominal tuberculous lymphadenitis diagnosed by percutaneous needle biopsy under ultrasound control and followed up by ultrasound imaging]. 867 93

In the same manner as syphilis, tuberculosis (TB) was often called "The Great Imitator". We have to consider not only malignancies but also TB as a differential diagnosis when we find any tumorous regions. We report herein on a rare case, clavicular osteomyelitis due to TB. A 72-year-old female, with diabetic nephropathy, was on maintenance hemodialysis. She had a fall 2 months prior to admission followed by pain around her right clavicle. Ulceration occurred in that region a month prior to admission, and CT scan revealed a fracture of the right clavicle with a tumor surrounding that area. Seven days prior to admission, she went to a neurologist because of dizziness. MRI of the brain revealed a tumor in her pons. The physician suspected the tumor was metastasis. Needle biopsies revealed only necrotic tissue so the medical oncologist consulted us because they suspected it was caused by infection of some kind. From the patient's history and the physical examination, we suspected TB osteomyelitis and grew some more cultures, but only MRSA and E. coli were detected. We administered vancomycin and cefmetazole for the secondary bacterial osteomyelitis. After a month of hospitalization, we found miliary regions on her chest CT and Mycobacterium tuberculosis was grown from the needle biopsy specimen. We started multi-antituberculosis therapy and the patient had a good prognosis. We report herein on a rare case of clavicular osteomyelitis due to TB, together with a review of the literature.
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PMID:[The Great Imitator; Clavicular Tuberculosis Mimics a Metastatic Neoplasm]. 2663 Jul 91

BACKGROUND Lymphoma complicated with hemophagocytic syndrome and tuberculosis has been rarely reported. The clinical and radiological presentation of these potentially fatal conditions can be easily confused and there is a potential for misdiagnosis. CASE REPORT We present a 58-year-old Hispanic female who was admitted to the hospital with dizziness and fever. Her initial admission diagnosis was severe sepsis secondary to community acquired pneumonia. She was started on intravenous antibiotics. Due to mediastinal lymphadenopathy, lymphoma was considered as a differential diagnosis for which she underwent bronchoscopy and endobronchial ultrasound-guided sampling of her mediastinal lymph nodes. Lymph node aspirate was suggestive of lymphoma. Initial cultures were negative. Her clinical course was complicated with respiratory failure, cytopenia, and rapidly progressive cervical lymphadenopathy. The patient underwent cervical lymph node excision and bone marrow biopsy. The pathology of the lymph nodes confirmed T cell lymphoma, and bone marrow revealed hemophagocytosis. The patient was started on chemotherapy but she continued to deteriorate and died on day 20 of her hospital admission. Post-mortem results of cultures from a cervical lymph node biopsy and PCR were positive for Mycobacterium tuberculosis. CONCLUSIONS We suggest an aggressive tissue diagnosis with staining for acid-fast bacilli for early diagnosis in patients presenting with hemophagocytic syndrome secondary to lymphoma as coexisting tuberculosis is a consideration. Tuberculosis re-activation should be considered in patients from an endemic region who present with lymphoma and a deteriorating clinical condition.
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PMID:An Unusual Triad of Hemophagocytic Syndrome, Lymphoma and Tuberculosis in a Non-HIV Patient. 2866 77