Asunto(s)
Antituberculosos , Enfermedad de Crohn , Infliximab , Mucosa Bucal , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Bucal , Adulto , Antituberculosos/administración & dosificación , Antituberculosos/clasificación , Biopsia/métodos , Mejilla , Enfermedad de Crohn/tratamiento farmacológico , Enfermedad de Crohn/inmunología , Diagnóstico Diferencial , Femenino , Fármacos Gastrointestinales/administración & dosificación , Fármacos Gastrointestinales/efectos adversos , Fármacos Gastrointestinales/inmunología , Humanos , Infliximab/administración & dosificación , Infliximab/efectos adversos , Infliximab/inmunología , Mucosa Bucal/lesiones , Mucosa Bucal/microbiología , Mucosa Bucal/patología , Enfermedad Relacionada con los Viajes , Resultado del Tratamiento , Tuberculosis Bucal/diagnóstico , Tuberculosis Bucal/tratamiento farmacológico , Tuberculosis Bucal/etiología , Tuberculosis Bucal/fisiopatología , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresRESUMEN
The authors report an unusual case of acute, rapidly progressive, unilateral neck swelling following extubation after elective left anterior temporal lobectomy with amygdalohippocampectomy. Due to severe neck swelling, the patient developed critical airway compromise, brachial plexopathy, and Horner's syndrome. After critical airway management and appropriate rehabilitation, the patient recovered completely and remains seizure free at 1.5 years of follow-up. This case highlights the importance of early recognition of acute postoperative sialadenitis and the steps needed to prevent serious morbidity and possible mortality from this rare complication.
Asunto(s)
Extubación Traqueal/efectos adversos , Obstrucción de las Vías Aéreas/etiología , Lobectomía Temporal Anterior/efectos adversos , Craneotomía/efectos adversos , Sialadenitis/etiología , Tuberculosis Bucal/etiología , Adolescente , Extubación Traqueal/métodos , Manejo de la Vía Aérea , Obstrucción de las Vías Aéreas/diagnóstico por imagen , Obstrucción de las Vías Aéreas/terapia , Amígdala del Cerebelo/diagnóstico por imagen , Amígdala del Cerebelo/cirugía , Lobectomía Temporal Anterior/métodos , Craneotomía/métodos , Epilepsia Refractaria/complicaciones , Epilepsia Refractaria/diagnóstico por imagen , Epilepsia Refractaria/cirugía , Femenino , Hipocampo/diagnóstico por imagen , Hipocampo/cirugía , Humanos , Sialadenitis/diagnóstico por imagen , Sialadenitis/terapia , Tuberculosis Bucal/diagnóstico por imagen , Tuberculosis Bucal/terapiaRESUMEN
PURPOSE: Radioactive iodine (RAI) ablation therapy after thyroidectomy commonly leads to obstructive sialadenitis. Magnetic resonance (MR) sialography is an emerging imaging modality that enables morphological and functional changes to be evaluated. This study was conducted to investigate the usefulness of MR sialography for the evaluation of RAI sialadenitis. In addition, the authors evaluated the correlation of MR sialographic grading with symptom severity using a symptom questionnaire (SQ), and salivary gland (SG) functions as determined by salivary flow rates (SFRs) and salivary scintigraphy (SSG) parameters. METHODS: Eighteen patients with RAI sialadenitis who underwent MR sialography imaging were retrospectively enrolled. Subjective symptom scores were assessed and objective SG functions were evaluated. MR sialographic characteristics were analyzed and correlations between MR sialographic findings and clinicopathologic data, SQ, SFRs, and SSG parameters were investigated. RESULTS: MR sialography demonstrated diagnostic findings of ductal stenosis and sialectasis, non-visualized ducts, and glandular atrophy mainly involving parotid glands. A significant correlation was found between obstructive symptom scores and ductal stenosis and sialectasis grades (both p < 0.05). Degrees of ductal stenosis and sialectasis were significantly correlated with SSG excretory variables [time from stimulation to minimum count (t min) and maximum secretion; all p < 0.05]. Significant linear correlations were found between duct nonvisualization and uptake variables [uptake ratio (UR) and maximum accumulation (MA); both p < 0.05]. Glandular volumes were also significantly correlated with UR and MA (both p < 0.05). CONCLUSIONS: MR sialography images are useful for evaluating RAI sialadenitis, and its findings are in accordance with disease severity. An MR sialographic grading system is suggested to describe the severity of obstructive sialadenitis and SG dysfunction.
Asunto(s)
Procesamiento de Imagen Asistido por Computador/métodos , Radioisótopos de Yodo/efectos adversos , Imagen por Resonancia Magnética/estadística & datos numéricos , Sialadenitis/diagnóstico , Sialografía/estadística & datos numéricos , Tuberculosis Bucal/diagnóstico , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Sialadenitis/etiología , Tuberculosis Bucal/etiologíaRESUMEN
The treatment of rheumatoid arthritis (RA) with tumor necrosis factor α (TNF-α) inhibitors has been associated with an increased risk of tuberculosis (TB). Most patients have extrapulmonary disease. We describe a case of tonsil TB in an RA patient treated with methotrexate for 23 years and adalimumab (TNF-α inhibitor) for the last 3 years after an initial negative PPD (purified protein derivative of tuberculin) skin test. Our patient presented with a tonsil ulcer. PPD skin test was now positive; biopsy result of the lesion revealed Mycobacterium tuberculosis on culture, and a granuloma typical of TB on histologic assessment. The patient received antituberculous treatment with complete resolution of the lesion. This case illustrates that oral TB can occur after long treatment with TNF-α inhibitor and that tuberculous granulomas can be formed in such patients.
Asunto(s)
Anticuerpos Monoclonales/administración & dosificación , Antirreumáticos/administración & dosificación , Artritis Reumatoide/tratamiento farmacológico , Inmunosupresores/administración & dosificación , Metotrexato/administración & dosificación , Tuberculosis Bucal/diagnóstico , Adalimumab , Anciano , Anticuerpos Monoclonales Humanizados , Artritis Reumatoide/complicaciones , Artritis Reumatoide/microbiología , Esquema de Medicación , Humanos , Masculino , Tonsila Palatina , Tuberculosis Bucal/tratamiento farmacológico , Tuberculosis Bucal/etiologíaAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Tuberculosis Bucal/etiología , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Adulto , Fármacos Anti-VIH/uso terapéutico , Antituberculosos/uso terapéutico , Fiebre/etiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , VIH-1 , Humanos , Labio/microbiología , Enfermedades Linfáticas/etiología , Masculino , Úlceras Bucales/microbiología , Lengua/microbiología , Tuberculosis Bucal/diagnóstico , Tuberculosis Bucal/tratamiento farmacológico , Pérdida de PesoRESUMEN
Osteomyelitis of jaws caused by infection with Mycobacterium tuberculosis is uncommon, especially in children. We present a case of tuberculous osteomyelitis in a young child. Its clinical presentation, with features similar to a dento-alveolar abscess, underline the importance of considering it in the differential diagnosis of jaw lesions. We discuss of the diagnostic techniques, management and preventive measures, and stress the importance of history taking during clinical examination.
Asunto(s)
Enfermedades Mandibulares/diagnóstico , Enfermedades Mandibulares/terapia , Tuberculosis Bucal/diagnóstico , Tuberculosis Bucal/terapia , Antituberculosos/uso terapéutico , Preescolar , Drenaje , Femenino , Humanos , Enfermedades Mandibulares/etiología , Osteomielitis/diagnóstico , Osteomielitis/terapia , Granuloma Periapical/etiología , Granuloma Periapical/cirugía , Radiografía , Extracción Dental/efectos adversos , Tuberculosis Bucal/etiología , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico por imagenRESUMEN
Tuberculous parotitis, particularly the diffuse form, is rare. I describe here three patients with diffuse tuberculous parotitis, two of whom presented with unilateral parotid swelling while the third had swellings of both glands. All had discharging sinuses. In two of the patients, the parotitis was associated with active pulmonary tuberculosis. In the patient with bilateral parotitis, the disease seemed to be confined to the glands. The diagnosis of tuberculosis was confirmed by the finding of tubercle bacilli in the lesion or the sputum. They all responded well to standard antituberculous drugs.
Asunto(s)
Parotiditis/microbiología , Tuberculosis Bucal/patología , Adolescente , Adulto , Femenino , Humanos , Masculino , Parotiditis/etiología , Parotiditis/patología , Tuberculosis Bucal/etiología , Tuberculosis Pulmonar/complicacionesRESUMEN
Both secondary and primary tuberculosis of the tongue and oral cavity are rare. A case of tuberculosis of the tongue secondary to pulmonary tuberculosis in a 41-yr-old male patient is described. The clinical manifestation, diagnosis and response to the antituberculosis treatment are considered.
Asunto(s)
Enfermedades de la Lengua/etiología , Tuberculosis Bucal/etiología , Tuberculosis Pulmonar/complicaciones , Adulto , Antituberculosos/uso terapéutico , Quimioterapia Combinada , Humanos , Masculino , Enfermedades de la Lengua/tratamiento farmacológico , Tuberculosis Bucal/tratamiento farmacológico , Tuberculosis Pulmonar/tratamiento farmacológicoRESUMEN
OBJECTIVE: Tuberculosis isolated to the head and neck region is common in patients with HIV infection. However, the management of isolated head and neck tuberculosis has not been reported in the literature. This study was done to describe the characteristics of tuberculosis isolated to the head and neck region in patients infected with HIV and to detect differences in presentation and diagnostic management based on the status of HIV infection at presentation. METHODS: A retrospective study was performed including 38 patients infected with HIV who were seen with tuberculosis isolated to the head and neck region at two tertiary care centers during a 10-year period. These patients were divided into two groups on the basis of the HIV status at presentation, which indirectly reflects the level of immunosuppression. Group 1 included 11 patients (29%) with AIDS at presentation. Group 2 included 27 patients (71%) with HIV infection but not AIDS. RESULTS: The cervical lymphatics were the most common site for isolated head and neck tuberculosis (89%), with the supraclavicular nodes most often involved (53%). Extralymphatic involvement was less common (11%), but involved a variety of anatomic locations (skin, spinal cord, larynx, parotid). The presenting history and physical examination had a low sensitivity for tuberculosis in patients with HIV infection, mainly because of the presence of multiple confounding factors. Purified protein derivative testing was highly sensitive for tuberculosis in patients with HIV infection alone (61 %); however, its usefulness was diminished in patients with AIDS (14%; p=0.03). Fine-needle aspiration biopsy was 94% sensitive for diagnosing tuberculosis and was not affected by the status of HIV infection. Surgical biopsy was the gold standard for diagnosing tuberculosis but was associated with chronically draining fistulas in a significant number of cases (14%). CONCLUSIONS: These data suggest that tuberculosis should be considered in the differential diagnosis of all head and neck lesions in patients infected with HIV, even in the absence of pulmonary involvement. Purified protein derivative testing should be done liberally in these patients, with realization that the sensitivity of purified protein derivative testing is reduced in patients with AIDS. Fine-needle aspiration biopsy should be the key diagnostic test in this patient population, with open surgical biopsy reserved for highly suspicious cases in which other measures were not diagnostic.
Asunto(s)
Infecciones por VIH/complicaciones , Tuberculosis/etiología , Adulto , Biopsia con Aguja , Femenino , Humanos , Masculino , Cuello , Estudios Retrospectivos , Sensibilidad y Especificidad , Prueba de Tuberculina , Tuberculosis/diagnóstico , Tuberculosis Laríngea/etiología , Tuberculosis Ganglionar/etiología , Tuberculosis Bucal/etiología , Tuberculosis de la Columna Vertebral/etiologíaRESUMEN
A case of secondary gingival tuberculosis is presented. The case is 51 year-old male who had been suffering from undetected pulmonary tuberculosis visited a dentist because of chronic periodontal inflammation around the gingiva of the right upper and left lower molar teeth lasting for one year. The lesions remained unchanged and painful granulomatous swelling sustained in spite of the conservative treatment. The case was treated with the extraction of six teeth due to continued toothache. By pathohistological examination of gingiva and chest X-ray examination, the case was diagnosed as tuberculosis. Chest roentgenogram showed active pulmonary tuberculosis, and bacteriological examination of sputum showed tubercle bacilli. The administration of INH, RFP and EB was started, and the response to the treatment was good and the pain in the gingiva disappeared within three weeks. Secondary gingival tuberculosis is manifested as local granulomatous lesions with severe pain. The incidence of gingival tuberculosis is very rare, but we have to keep in mind that the oral tuberculosis secondary to pulmonary tuberculosis could occur.
Asunto(s)
Enfermedades de las Encías/etiología , Tuberculosis Bucal/etiología , Tuberculosis Pulmonar/complicaciones , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Enfermedades Mandibulares/patología , Infección de la Herida Quirúrgica/microbiología , Extracción Dental/efectos adversos , Tuberculosis Ganglionar/patología , Tuberculosis Bucal/patología , Adulto , Antituberculosos/uso terapéutico , Diagnóstico Diferencial , Femenino , Humanos , Enfermedades Mandibulares/etiología , Enfermedades Mandibulares/microbiología , Osteomielitis/diagnóstico , Infección de la Herida Quirúrgica/tratamiento farmacológico , Tuberculosis Ganglionar/tratamiento farmacológico , Tuberculosis Ganglionar/etiología , Tuberculosis Bucal/tratamiento farmacológico , Tuberculosis Bucal/etiologíaRESUMEN
Tuberculosis of the oral mucosa was associated with pulmonary tuberculosis in a 38-year-old white man. The patient presented with multiple oral ulcerations with an irregular periphery and a granular vegetative fundus. The oral lesions antedated the findings of primary pulmonary tuberculosis, and the diagnosis was initially established histologically. Through the differential diagnosis of oral ulcerations, the dentist can play a role in the early detection of tuberculosis.
Asunto(s)
Enfermedades de la Boca/patología , Enfermedades de la Lengua/patología , Tuberculosis Bucal/patología , Tuberculosis Pulmonar/complicaciones , Adulto , Biopsia , Mejilla , Diagnóstico Diferencial , Humanos , Masculino , Enfermedades de la Boca/etiología , Mucosa Bucal/patología , Lengua/patología , Enfermedades de la Lengua/etiología , Tuberculosis Bucal/etiologíaRESUMEN
A case with oral tuberculosis and unaware of systemic tuberculosis is reported. The oral lesions clinically manifested as two painless ulcerations in the hard palate. Pulmonary tuberculosis was diagnosed following the histopathologic and bacteriologic examination of the oral lesions.
Asunto(s)
Úlceras Bucales/microbiología , Tuberculosis Bucal/etiología , Tuberculosis Pulmonar/complicaciones , Anciano , Femenino , Humanos , Mycobacterium tuberculosis/aislamiento & purificación , Hueso Paladar/microbiología , Hueso Paladar/patología , Tuberculosis Bucal/diagnósticoRESUMEN
A patient with Hodgkin's disease (HD) underwent autologous bone marrow transplantation (ABMT). Six months later while receiving interleukin (IL)-2 and alpha-interferon immunotherapy, he developed a painful lesion in his oral cavity with a fistula in the buccal area. Excision biopsy disclosed necrotizing granulomatous inflammation with acid-fast bacillus. The patient received a 9-month course of isoniazide, rifampin and pyrazinamide, and recovered. The possible pathophysiological mechanism is discussed.
Asunto(s)
Adyuvantes Inmunológicos/efectos adversos , Trasplante de Médula Ósea , Enfermedad de Hodgkin/terapia , Interferón-alfa/efectos adversos , Interleucina-2/efectos adversos , Infecciones Oportunistas/etiología , Tuberculosis Bucal/etiología , Adyuvantes Inmunológicos/uso terapéutico , Adulto , Antibacterianos , Antituberculosos/uso terapéutico , Terapia Combinada , Susceptibilidad a Enfermedades , Quimioterapia Combinada/uso terapéutico , Fístula/etiología , Enfermedad de Hodgkin/complicaciones , Humanos , Huésped Inmunocomprometido , Interferón-alfa/uso terapéutico , Interleucina-2/uso terapéutico , Isoniazida/uso terapéutico , Masculino , Úlceras Bucales/etiología , Pirazinamida/uso terapéutico , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/uso terapéutico , Rifampin/uso terapéutico , Factores de Riesgo , Acondicionamiento Pretrasplante/efectos adversos , Trasplante Autólogo , Tuberculosis Bucal/tratamiento farmacológicoRESUMEN
A 4-year-old child with probable multifocal BCG osteomyelitis is reported. The lesions in the skull, clavicula, humerus, ribs, fibula, calcaneus, metatarsus, and hard palate were mainly osteolytic and healed rapidly with antituberculotic therapy. This is the first time that involvement of the hard palate has been described.