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Genitourinary tuberculosis in a 54-year-old woman: diagnostic difficulty

100%
Agca H., Baylan O., Ozyurt M., Acar A., Demirpek U., Haznedaroglu T.
Open Medicine
|
2010
|
vol. 5
|
issue 5
569-572
EN
Genitourinary tuberculosis (GUTB) is an extrapulmonary manifestation of tuberculosis seen in 1.2% of all cases of tuberculosis. The clinical case of a 54-year-old woman diagnosed with GUTB is presented. Cloudy urine, abdominal pain, and microscopic hematuria led us to investigate for Mycobacterium tuberculosis. Although cultures were negative, positive Ehrlich-Ziehl-Neelsen (EZN) staining and a positive polymerase chain reaction (PCR) revealed the diagnosis of M. tuberculosis complex (MTC), which was confirmed by treatment success. It has been shown that PCR is a reliable and rapid method for establishing or supporting the diagnosis of tuberculosis and can be used in a routine diagnostic algorithm when conventional methods fail to identify MTC.
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Coexistence of pancreatic tuberculosis with systemic brucellosis: a case report

84%
Acar A., Sücüllü İ., Baylan O., Filiz A., Diktaş H., Kıvanc M., Öncül O., Görenek L.
Open Medicine
|
2010
|
vol. 5
|
issue 5
573-576
EN
Isolated pancreatic tuberculosis is an extremely rare clinical entity and is difficult to diagnose particularly in immunocompetent individuals. Clinical findings and symptomatology of brucellosis are often similar to tuberculosis thus making the differentiation amongst the two entities difficult. We report a case of pancreatic tuberculosis with systemic brucellosis in a 29 year old veterinarian who presented with epigastric pain and loss of appetite. Initial investigations revealed leukocytosis with moderately elevated transaminase, gamma glutamyl transferase, amylase and lipase levels. Imaging studies revealed an anechoic multiloculated cyst in the body and tail of the pancreas. Given the patient’s occupational risk coupled with the presence of a positive Brucella agglutination test (with a titer of 1:320); a diagnosis of pancreatitis secondary to brucellosis was given. In addition to standard pancreatitis therapy of bowel rest with intravenous fluid/electrolyte replacement, anti-brucellosis therapy was also administered. The patient’s initial response to therapy was positive however, 6 weeks into therapy, his abdominal pain recurred and repeat CT scan revealed the development of a pseudocyst in the pancreas. After failing a second attempt at conservative supportive therapy, the patient underwent an explorative laparotomy. Histological examination of the resected pancreatic specimen showed necrosis and was positive for tuberculosis by polymerase chain reaction. Herein, we describe the first case reported in the medical literature of the coexistence of systemic brucellosis with pancreatic tuberculosis. We suggest that the possibility of the coexistence of brucellosis with tuberculosis be kept in mind when assessing pancreatitis patients in endemic regions and in individuals with occupational risk hazards.
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