Mycobacterium tuberculosis as cause of a cerebral spindle cell tumor in an HIV patient (original) (raw)
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Esophageal tuberculosis in an HIV-positive patient mimicking a spindle cell tumor
2019
Tuberculosis (TB) of the esophagus is an extremely rare condition, even in immunocompromised patients. We report the case of a 24-year-old man with a past history of HIV and pulmonary tuberculosis who presented with dysphagia and a 2cm submucosal mass in the proximal esophagus. The biopsy was diagnosed as a spindle cell neoplasm in another center. Sections displayed a submucosal lesion formed by spindle and epithelioid cells, surrounded by chronic inflammation. The spindle cells were positive for S100 and CD68, but negative for cytokeratin, desmin, smooth muscle actin, ALK, CD34 and CD117. Ziehl-Neelsen stain was performed and showed many intracellular acid-fast bacilli, confirming the diagnosis of esophageal TB. This case is a reminder that esophageal TB may become manifest as a submucosal lesion and the histiocytic-granulomatous reaction may mimic a spindle cell tumor.
Cerebral tuberculomas in AIDS patients: a forgotten diagnosis?
Arquivos de Neuro-Psiquiatria, 2004
The human immunodeficiency virus (HIV) infection epidemics increased the prevalence, multi-drug resistance and disseminated forms of tuberculosis. The central nervous system (CNS) tuberculosis has high mortality and morbidity, and it is usually divided into diffuse (meningitis) and localized (tuberculoma and abscess) forms. We report three cases of cerebral tuberculomas in AIDS patients: one with definitive diagnosis, confirmed with histopathology, and two with probable diagnosis, based on clinical information, radiological images, Mycobaterium tuberculosis isolation out of the CNS and adequate response to antituberculous treatment. Further, we discuss diagnostic, therapeutic and prognostic issues of tuberculomas, with emphasis in the distinction from cerebral tuberculous abscesses. Despite of their infrequent presentation, tuberculomas should be considered in the differential diagnosis of cerebral expansive lesions in patients with AIDS.
Clinical Infectious Diseases, 2004
Background. The tuberculosis epidemic is still a global emergency, and its spread in the past 20 years has been fueled by the acquired immune deficiency syndrome pandemic and increasing drug resistance. International travel and migration may increase the incidence of tuberculosis in industrialized countries. Methods. We reviewed the clinical charts of patients admitted to the infectious diseases unit of Ospedali Riuniti (Bergamo, Italy) to identify patients with intracranial mass lesions caused by Mycobacterium tuberculosis. Results. During the past 6.5 years, 5 of 30 patients with a mass of infectious origin in the brain had tuberculous brain lesions diagnosed. All 5 were human immunodeficiency virus (HIV)-negative adults and African immigrants. No patient had concomitant meningitis, 1 had a concomitant pulmonary disease, and 3 subjects reported a past history of tuberculosis. At presentation, no patient had fever and 3 had seizures. Examination of cerebrospinal fluid revealed normal findings for 4 of 4 subjects, and neuroimaging showed multiple intracranial mass lesions in 4 of 5 patients. The diagnosis was definite for 2 subjects (based on analysis of brain specimens) and presumptive for 3 subjects (1 had concomitant pulmonary tuberculosis, and 2 had clinical response to therapy). Results of susceptibility tests for M. tuberculosis were available for 2 patients: both isolates were resistant to isoniazid, and 1 was also resistant to streptomycin. Duration of medical treatment ranged from 11 to 23 months, and 2 subjects underwent surgical procedures at the time of diagnosis. All 5 patients recovered. Conclusions. Clinicians in western countries should consider the possible role of tuberculosis in causing mass lesions in the brain, particularly in immigrants from regions where tuberculosis is endemic.
Histological Features of Tubercular Lymphadenitis in HIV Positive Patients
Advances in Cytology & Pathology, 2017
Tuberculosis is one of the most common causes of lymphadenopathy in HIV positive patients. Though the presenting complaint is same as non HIV patient, the histologic features of lymph node biopsy varies depending on the immune status. The present study is conducted to find out these differences and its relevance in diagnosis. Material and methods: The histological features seen on lymph node biopsies, done on HIV positive patients who presented with lymphadenopathy, with or without other systemic manifestations over a period of three years were analysed. Seventy four lymph node biopsies were found adequate and provided the material for the present study. The lymph nodes biopsies were fixed in 10% formalin and were stained using Haematoxylin and eosin (H&E) stain. Sections were stained for AFB by using Ziehl-Neelson method if H & E stained slides showed features suggestive of tuberculosis on light microscopy. Results: In the current study, 33 cases (44%) were diagnosed as tuberculous lymphadenitis and was the second most common cause of lymphadenopathy. The CD4 counts of all these patients ranged from 10-258/µl with the CD4 count being<200 in 84.8% of cases. In the present study, granulomas were detected in 90.9% of the cases and were the most common and conspicuous feature. Confluent granulomas were more commonly seen than discrete ones. Most of the cases of caseating (75%) had more than 1 AFB/hpf whereas in the remaining cases (25%), number was less than 1/100hpf. Granulomatous lymphadenitis without caseous necrosis was seen in 2 cases (6.7%). Microabscess with granular debris without coexisting granuloma was found in 11 cases (33.3%) and all showed acid fast bacilli on Ziehl-Neelsen stain. Other features noted in present study were plasmacytosis (57.6%), paracortical expansion (12.1%) and periadenitis(30.3%). In the present study, AFB was positive in all the 33 cases. Two cases were diagnosed as tuberculosis on biopsies and confirmed as atypical mycobacterium. Conclusion: Lymph node biopsy is a valuable tool in the evaluation of HIV positive patient to identify the causes of lymphadenopathy.
Cerebral tuberculoma — A comparative study in patients with and without HIV infection
Infection, 1995
The microbiological, clinical and radiological findings of cerebral tuberculomas in four patients with and in five patients without HIV infection were compared. The study was carried out during the last 14 years. The CT scans were analyzed in a blinded fashion. Cerebral tuberculoma in HIV-negative patients was clinically characterized by seizures, while in HIV-positive patients this finding was absent. All four HIV-infected patients had headache and fever and their CSF showed lymphocytic meningitis. Two HIV-negative and three HIV'positive patients had concurrent extracerebral tuberculosis. In HIV-infected patients, the cerebral tnberculoma was a secondary finding of disseminated tuberculosis. In our small patient samples, the cerebral tuberculoma presented as spontaneous hypodense cerebral lesions in all the HIV-positive patients but as a hyperdense cerebral lesion in the HIV-negative patients. Two patients of each group had ring enhancement lesions. Cerebral tubercuioma was diagnosed in about 4 weeks for HIV-positive patients, but took some 16 weeks for HIV-negative patients, the latter being first suspected of having a cerebral tumor or bacterial abscess. Diagnostic craniotomy was thus necessary for the HIV-negative patients. One patient of each group died as a consequence of cerebral tuberculoma, all the remaining patients improved with treatment.
TUBERCULOUS BRAIN ABSCESS IN A PATIENT WITH HIV INFECTION
Tuberculous Brain Abscess (TBA) is a rare manifestation of CNS tuberculosis. Only a few cases have been reported in literature. A twenty six year old male presented with high grade fever, throbbing headache and altered sensorium. Examination revealed neck stiffness and papilloedema. His chest X-ray showed evidence of healed pulmonary tuberculosis. MRI Brain showed a well circumscribed hyper intense lesion in the left parietal region with perilesional edema and mass effects.