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Fourteen patients with tuberculosis of the orbit and lacrimal gland seen over a period of 20 years have been presented. The majority of them were between the ages of 4 to 15 years. Males were affected twice as frequently as females. Left side was affected four times as frequently as the right side. There were eight patients of periostitis of orbital margin, one patient of dacryoadenitis, three patients of tuberculoma of orbital tissues, and two patients of tuberculoma of maxillary sinus. One patient with periostitis had involvement of the greater and lesser wings of sphenoid in addition to the involvement of upper-outer orbital margin. Two periostitis patients had prolapse of the palpebral portion of the lacrimal gland. The clinical presentation and gross appearance of the tuberculoma of the lacrimal gland was similar to those found in benign mixed tumor. The patients with tuberculoma of orbital tissues presented as pseudotumors. The mimicry of tuberculoma of maxillary sinus to carcinoma has been mentioned. Associated tuberculous lesions were pulmonary in eight patients, cervical lymphadenitis in ten patients, intestinal in one patient, and caries spine in one patient. In two patients the disease developed in the absence of any other tuberculous lesion discovered in the body. The cases were cured by wide surgical removal of all the diseased tissues combined with antituberculous chemotherapy.
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PMID:Tuberculosis of the orbit and lacrimal gland: a clinical study of 14 cases. 741 35

Endoscopic ultrasound (EUS) was designed for the evaluation of malignancies; however, its utility has been extended to the assessment of benign disorders, which include inflammatory bowel diseases. Topics discussed in this article include instruments and methods, EUS images in various inflammatory diseases, clinical severity and EUS typing, endoscopic grading of inflammation and EUS typing, extent of disease involvement and EUS typing, response to therapy and EUS typing, changes in EUS findings by treatment, Crohn's disease, radiation proctitis, ischemic colitis, tuberculosis, and mucosal prolapse syndrome.
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PMID:Endoscopic ultrasonography in inflammatory bowel diseases. 853 34

Cerebral tuberculoma is a rare entity and is one of the causes of intracerebral mass lesions. A rapid diagnosis based on pathological findings improves its prognosis. We describe two cases where the tuberculoma was located in the cavernous sinus and prepontine cistern, respectively. The first case was a 36-year-old man who was admitted with progressive headache, left ptosis and diplopia. Computed tomography showed a solid enhancing mass in the left cavernous sinus. Diagnosis of meningioma was proposed and a left pterional craniotomy was performed. Histopathological examination revealed granulomatous inflammation with areas of caseation necrosis. The second case was a 20-year-old man who presented with headache, new-onset strabismus, diplopia, malaise, weight loss and low-grade fever. The lesion mimicked an aggressive meningioma on imaging. The patient was operated for primary diagnosis of cerebral tumour. The histopathological examination of the excised lesion revealed a tuberculoma. Although the incidence of tuberculosis is decreasing, a high index of suspicion must be maintained for the diagnosis of intracranial masses in the presence of risk factors for tuberculosis.
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PMID:Cerebral tuberculosis mimicking intracranial tumour. 1630 50

Tuberculosis of the uterine cervix is an uncommon disease. Two cases of unsuspected cervical tuberculosis are reported. In Case 1, the patient presented with primary infertility. In Case 2, the patient had procidentia with decubitus ulcer and purulent vaginal discharge. In both the cases, the patients had secondary amenorrhoea. The differential diagnoses and role of other diagnostic aids are discussed.
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PMID:A report of two unsuspected cases of cervical tuberculosis. 1676 65

Fungal infections of the spine are very rare and usually seen in immunocompromised patients. Acute cauda equina syndrome presenting in an immunocompetent patient is usually due to a prolapse of the intervertebral disc. Infective pathology caused by Mycobacterium tuberculosis with epidural collection can also have a similar presentation. We present a case of spinal epidural abscess caused by Aspergillus fumigatus, presenting as acute cauda equina syndrome. To the best of our knowledge, spinal aspergillosis presenting as cauda equina syndrome in an immunocompetent patient has not been reported before in the English-language based medical literature. Surgical decompression with antifungal treatment with oral itraconazole yielded a good recovery.
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PMID:A rare etiology of cauda equina syndrome. 2133 Jul 47

Genitourinary tuberculosis is one of the common forms of extrapulmonary tuberculosis. We report a case of atypical genitourinary tuberculosis: massive uterovaginal prolapse with cervical lesion mimicking cervical carcinoma. This particular case highlights the problem of healthcare in most of the developing countries. Lack of patient education, awareness, and access to a healthcare system resulted in a complicated situation. In an endemic area or in an immunocompromised individual, a higher index of suspicion would allow early recognition and treatment institution to minimise its late consequences as well as spreading of the disease. Though anti-TB is the mainstay of treatment, surgical intervention might be needed in selected cases.
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PMID:Genitourinary tuberculosis: an atypical clinical presentation. 2332 Feb 16

We report a rare case of acute, septic cavernous sinus thrombosis (SCST) caused by tuberculosis infection. The diagnosis of SCST was suspected and rapidly confirmed based on high fever, dramatic and typical signs of left cranial nerve paralysis and the result of digital subtraction angiography after the onset of the disease. However, the diagnosis of tuberculosis infection was missed, and the 55-year-old patient was treated with high-dose glucocorticoid, anticoagulants and a series of intravenous antibiotics for bacteria. His symptoms failed to improve, and steroid treatment resulted in serious haematogenous dissemination of Mycobacterium tuberculosis, including miliary tuberculosis and tuberculosis verrucosa cutis, which led to the final diagnosis. Then, the patient received a five-agent antituberculosis treatment. He was recently followed up with only the sequelae of left side ptosis and oculomotor weakness.
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PMID:Septic cavernous sinus thrombosis caused by tuberculosis infection. 2542 49

Tuberculous meningitis (TBM) remains the most dangerous form of tuberculosis with high mortality and potential complications. The prompt diagnosis and treatment of this condition remains a key for better prognosis. A 39-year-old woman presented with severe headache, fever, nausea and vomiting, with a history of headache for a month. On examination, confusion, neck rigidity, ptosis and upward plantar reflexes were present. After 7 days of empiric treatment without resolution of her symptoms, she had another spinal tap performed. The diagnosis of TBM was performed by the GeneXpert MTB/RIF assay from her cerebrospinal fluid (CSF). Antitubercular chemotherapy was started. The patient subsequently improved. Where available, the GeneXpert assay should be used immediately in CSF samples of patients suspected of TBM as an adjunct to clinical algorithms to increase the chance of a prompt diagnosis and treatment.
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PMID:GeneXpert MTB/RIF assay as initial test for diagnosis of tuberculous meningitis. 2607 38

Tuberculosis involving the central nervous system, a source of considerable morbidity and mortality, forms 5-10% of the disease burden associated with tuberculosis. Central nervous system tuberculosis may present as meningitis, tuberculoma, abscesses, cerebritis or miliary tuberculosis. The most common site of tuberculoma has been reported to be at the grey-white matter junction and the periventricular region. They may even be found in the epidural, subdural and subarachnoid spaces, and the brain stem, with the rarer sites of involvement being the cavernous sinus, sella turcica, hypophysis, hypothalamus, sphenoid sinus and the mastoid air cells. Although tuberculosis is very common in developing countries, with the increasing prevalence of immunosuppression owing to human immunodeficiency virus and patients surviving chemotherapy or organ transplantation, the incidence of tubercular infections has been rising in developed countries. The authors report a case of intracranial tuberculosis in a human immunodeficiency virus-negative patient, who underwent incomplete treatment for tubercular peritonitis and presented with unilateral ptosis. Tuberculous involvement was noted in a racemose pattern in the subarachnoid space, cavernous sinuses, suprasellar cistern and parasellar region. To the best of our knowledge, the term racemose pattern of tuberculoma has not been described before, while about 10 cases of tuberculoma involving the cavernous sinuses have been reported in the literature. Furthermore, the racemose pattern of tuberculosis in the subarachnoid space, as well as involvement of the cavernous sinus, hypothalamus, pituitary and the cisterns, developed paradoxically after initiation of antitubercular chemotherapy.
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PMID:A case report of racemose pattern of intracranial tuberculoma with brain stem and hypophyseal involvement developing paradoxically during treatment. 3046