Tuberculous axillary adenitis following application of P.P.D.
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BACKGROUND: Gut tuberculosis appears to be a rare diagnosis in Central Europe. The main diagnostic method is endoscopy with biopsy in order to win histology and a culture. By means of endoscopy the differential diagnosis to Crohn's disease is sometimes difficult. Computertomography and/or ultrasound can facilitate the diagnosis of gut tuberculosis. CASE REPORT: A 64-year-old woman presented in our hospital with cervical lymph nodes and ulcerations in the cecum and near the ileocecal valve. Major symptoms were abdominal pain, loss of weight, diarrhea and febrile temperature. Histology and culture revealed tuberculosis. The common antituberculotic therapy had to be stopped due to severe allergic reaction. After desensitization the patient could be treated successfully with a triple antituberculotic therapy without further complication. CONCLUSION: Beside the early treatment with tuberculotic drugs it is very important to consider the differentiation of a gut tuberculosis.
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Patients with anorexia nervosa (AN) seldom present with infectious illness, despite malnutrition-induced immunodeficiency. We described two young women who had a long-standing history of severe emaciation and pulmonary or lymph node tuberculosis discovered during the treatment of AN. Both patients reported a positive history of BCG vaccination. Contact tracing failed to reveal sources of infection, although the tuberculosis was considered transferred. Since the decline of notification rates for tuberculosis have been stagnant and outbreaks in schools or hospitals have been increasing in Japan, special attention must be given to the possibility of opportunistic infections in AN patients.
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A nine-month-old child received intermittent oral prednisolone over a 6 month period because of persistent wheezing. This therapy had appeared to improve his symptoms. At 15 months of age, a chest X-ray and culture of tracheal aspirate revealed disseminated pulmonary tuberculosis. Response to antituberculous therapy was slow, and withdrawal of steroids produced marked worsening of wheeze and respiratory distress. Corticosteroids are recognised adjuncts in the management of bronchial-lymph node tuberculosis. Responsiveness of wheezing to prednisolone does not imply that its cause is hyperreactive airways disease, and other causes should be sought particularly in developing countries.
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