Background: Topical NSAIDs have been proven to relieve the symptoms of osteoarthritis (OA) in short-term studies (2 weeks). To justify its chronic use, efficacy of a topical NSAID over a longer term of study should be demonstrated. The efficacy and safety of a topical diclofenac solution over a 6-week treatment course in symptomatic primary OA of the knee was investigated.

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Nucleic acid amplification tests are widely used in mycobacteriology laboratories to rapidly detect Mycobacterium tuberculosis complex directly in clinical specimens. A positive result provides an early diagnosis of tuberculosis, allowing initiation of appropriate therapy and public health measures.The Amplified Mycobacterium Tuberculosis Direct (MTD) test uses isothermal transcription-mediated amplification and a hybridization protection assay to detect rRNA from Mycobacterium tuberculosis complex (MTBC) in clinical specimens. The test is approved by the U.S. Food and Drug Administration for use with respiratory specimens that are acid-fast bacillus (AFB) smear positive and smear negative. Numerous published studies have demonstrated that the MTD test is also sensitive and specific when it is used to test nonrespiratory samples, including lymph nodes. Studies report that the specificity of the MTD test for nonrespiratory specimens ranges from 97.7 to 100% (3,5).This report describes a false-positive MTD test result from a smear-positive (and, ultimately, culture-negative) lymph node specimen from a patient later clinically diagnosed with lepromatous leprosy. The diagnosis was confirmed in the laboratory by a positive in-house PCR assay result for Mycobacterium leprae (6) and a negative PCR test result for M. tuberculosis (1).A 27-year-old male patient from India presented with a 4-month history of fever, anorexia, malaise, weight loss, and erythema nodosum-like lesions on his legs and forearms. A biopsy of an enlarged inguinal lymph node revealed caseating granulomata and numerous acid-fast positive bacilli on ZiehlNeelsen staining. A portion of the node was sent to the Central Public Health Laboratory (CPHL) for mycobacterial culture. Due to thenar muscle wasting, a biopsy of the skin on a forearm nodule was performed and confirmed a clinical diagnosis of leprosy. Fite staining of the initial lymph node demonstrated organisms which were morphologically typical of M. leprae. The formalin-fixed, paraffin-embedded skin biopsy specimen was submitted to CPHL for PCR testing for the detection of MTBC and M. leprae. The patient was initially treated for tuberculosis and leprosy. Treatment for tuberculosis was discontinued when cultures and PCR for M. tuberculosis were reported to be negative. The response to leprosy therapy was excellent.At the laboratory, the lymph node biopsy specimen was ground in a small amount of sterile buffer. The ground tissue was then processed by the standard NaOH-N-acetyl-L-cysteine method for 5 min. A fluorescence-stained smear of the processed tissue showed 3ϩ AFB. The MTD test was performed according to the laboratory protocol for new smearpositive specimens. Following the manufacturer's instructions a 450-l aliquot of the processed tissue was tested. Other aliquots were inoculated into two cultures, a Mycobacterium Growth Indicator Tube (Becton Dickinson, Sparks, MD) and a Lowenstein-Jensen solid medium slant. The cultures were incubated at 37°C for 7 weeks.The MTD test result was posi...