Abcès de la paroi thoracique et abdominale isolé : une forme exceptionnelle de tuberculose

Abid, Muhammad Bilal; Amar, Mohamed Ben; Abdenadher, M.; Kacem, Anis; Mohamed, Iman

doi:10.1016/j.rmr.2009.11.010

Cited by 16 publications

(25 citation statements)

References 7 publications

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“…5,9 Patients can also have multiple lesions and these can sometimes be painful. 7,[10][11][12][13][14][15][16][17] Empyema necessitatis can lead to serious destruction of bones, muscle and soft tissues, particularly the ribs. This may not produce symptoms until significant necrosis has already occurred.…”

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confidence: 99%

Tuberculous Empyema Presenting as a Persistent Chest Wall Mass: Case Report

Madeo¹,

Patel²,

Gebre³

et al. 2013

GERMS

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Empyema necessitatis is an empyema that spreads outside of the pleural space involving the chest wall. Tuberculosis is the most common cause. It occurs in both immunocompetent and immunocompromised patients. Due to the long latency period and the paucity of symptoms, diagnosis can be challenging. Clinicians must have a high awareness of this disease, especially in patients from endemic regions. The disease is treatable with surgical and medical interventions. Failure to diagnose can lead to grave consequences for both the individual patient and public health. This is particularly true in endemic regions where controlling the spread of TB is challenging. We report a rare presentation of pulmonary tuberculosis in an otherwise healthy 72-year-old USA immigrant from Thailand. He presented with a painless, chronic chest wall swelling with minimal systemic symptoms. Imaging revealed empyema necessitatis. Histopathology could not give a definitive diagnosis because the tissue was too necrotic. Despite negative acid-fast staining, sputum cultures were positive for tuberculosis. The case presentation is followed by a brief review of the current relevant literature. This case highlights the importance of clinical suspicion and increased awareness for this silent but serious infection.

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confidence: 99%

Tuberculous Empyema Presenting as a Persistent Chest Wall Mass: Case Report

Madeo¹,

Patel²,

Gebre³

et al. 2013

GERMS

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“…The infection is usually restricted to one muscle [6]. There may either be a frank tuberculous abscess (as seen in our case) or a nodular sclerosis followed by calcification.…”

Section: Discussionmentioning

confidence: 74%

Tuberculous Abscess of the Anterior Abdominal Wall: An Unusual Site of Presentation

Alawad¹

2015

Glob J Medical Clin Case Rep

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The skeletal muscles are rarely affected by tuberculosis because they are not a favorable site for the survival and multiplication of Mycobacterium tuberculosis. A case of tuberculous abscess in rectus abdominis muscle is described in a 20-year-old female in an apparently healthy individual without any past history of tuberculosis. The diagnosis was made by ultrasound-guided fine-needle aspiration and cytological examination which revealed caseating granuloma with central necrosis, lymphocytes, and giant cells, consistent with tuberculosis. After four weeks' antituberculous treatment, she responded well and the abscess regressed considerably. In most cases, the muscle involvement is secondary and is caused by either hematogenous route or direct inoculation from a tuberculous abdominal lymph node or extension from underlying tubercular synovitis and osteomyelitis. This case cautions the clinicians and radiologists about the possibility of tuberculosis in considering the differential diagnosis of any lesion even in any unlikely anatomical area, especially in those areas where tuberculosis is endemic.Laboratory investigation revealed: hemoglobin 11.5 g/dl; total leukocyte count 8510/cumm with a differential count of 54% neutrophils, 42% lymphocytes and 4% eosinophils; Erythrocyte Sedimentation Rate 70 mm and ELISA for HIV negative. The chest radiograph was unremarkable. Other biochemical blood investigations were within normal limits. Ultrasonography of the abdomen revealed a 6.5x8.5cm left iliac fossa cystic mass with a liquefied necrotic center in the anterior abdominal wall (Figure 1). Computerized Tomography scan of the abdomen showed an abscess in the left antero-lateral portion of the abdominal wall limited to the muscle layer (Figure 2). Ultrasound-guided fine-needle aspiration and cytological examination revealed caseating granuloma with central necrosis, lymphocytes, and giant cells, consistent with tuberculosis ( Figure 3). The patient was diagnosed to have tuberculous abscess of the anterior abdominal wall and antituberculosis treatment was started. She improved rapidly over the next few days. After four weeks' antituberculous treatment (ATT), she responded well to the IntroductionThe skeletal type of muscles are rarely affected by tuberculosis (TB) because they are not a preferred site for the survival and multiplication of Mycobacterium tuberculosis [1]. Even in patients with widespread involvement by the disease, tuberculosis rarely involves muscles. Petter et al. recorded only one case of primary skeletal muscles tuberculosis in over 8,000 cases of all types of tuberculosis, with an incidence of 0.015% [2]. Few cases of tubercular myositis have been described in literature till now, mostly in the adults. This, together with the decline in tuberculosis in general, makes it unlikely that one would immediately consider tuberculosis as the cause of rectus sheath abscess.There are only limited cases reports of isolated tubercular involvement of the anterior abdominal wall even though tuberculosis ...

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“…En milieu agricole, l´éventualité d´une inoculation directe transcutanée au niveau de la paroi thoracique est envisagée. Un cas compliquant une vaccination par le Bacille de Calmette et Guérin (BCG) a été rapporté [19]. Le siège parasternal est la localisation préférentielle, par le biais des ganglions intercostaux antérieurs qui sont le plus souvent concernés.…”

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“…Ceci étant sans doute en rapport avec l'amélioration de la prise en charge des cas de tuberculose dans notre pays grâce à la mise en place du programme national de lutte antituberculeuse. L'abcès tuberculeux peut souvent se fistuliser à la peau, c'est le cas d'un seul patient dans notre série, ou rarement donner une seconde localisation [15, 19]. Il s´observe dans les deux sexes avec une légère prédominance masculine [7].…”

Section: Discussionunclassified

“…Les antécédents de tuberculose sont rencontrés chez 83% des patients et une tuberculose active est concomitante dans 17,4% à 62,5% des cas [4, 7, 9, 15, 19, 21, 24]. Dans la série récente de Keum et al [3], 32,4% des patients avaient un antécédent de tuberculose ou une tuberculose active contre 62,9% dans celle de Paik et al [18] et seulement 5% des cas dans la notre.…”

Section: Discussionunclassified

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Les abcès froids pariétaux thoraciques chez les sujets immunocompétents

Benjelloun¹,

Sanaa²,

Zaghba³

et al. 2015

Pan Afr Med J

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Les abcès froids de la paroi thoracique représentent une forme rare et inhabituelle de tuberculose extrapulmonaire. Sa fréquence est estimée à moins de 5% des tuberculoses ostéoarticulaires, évaluées elles-mêmes à 15% des tuberculoses extrapulmonaires. L'objectif de ce travail est de rapporter la prise en charge diagnostique et thérapeutique de cette localisation dans notre structure. Etude rétrospective portant sur 18 cas colligés au service des maladies respiratoires du centre hospitalier universitaire Ibn Rochd de Casablanca, sur une période de 13 ans. La moyenne d’âge était de 34 ans (21-57). Un antécédent de tuberculose traitée était relevé dans un cas. Le tableau clinique était révélé par l'apparition insidieuse d'une masse pariétale de taille, de consistance et de siège variables. A l'imagerie thoracique, l'abcès pariétal était associé à une lyse osseuse dans sept cas, une atteinte parenchymateuse et pleurale dans quatre cas chacune et des adénopathies médiastinales dans deux cas. La confirmation diagnostique était bactériologique et/ou histologique dans tous les cas. La sérologie du virus de l'immunodéficience humaineétait négative chez tous nos malades. L’évolution sous traitement antibacillaire couplé ou non à une résection chirurgicale était favorable chez tous nos malades. Malgré la fréquence de la tuberculose dans notre contexte, la localisation pariétale thoracique reste rare, survenant chez une population non immunodéprimée et non toxicomane, contrairement à ce qui est souvent rapporté dans la littérature. Les abcès froids tuberculeux représentent une forme rare de tuberculose extrapulmonaire dont l’évolution reste favorable sous traitement précoce et bien conduit.

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Abcès de la paroi thoracique et abdominale isolé : une forme exceptionnelle de tuberculose

Cited by 16 publications

References 7 publications

Tuberculous Empyema Presenting as a Persistent Chest Wall Mass: Case Report

Tuberculous Empyema Presenting as a Persistent Chest Wall Mass: Case Report

Tuberculous Abscess of the Anterior Abdominal Wall: An Unusual Site of Presentation

Les abcès froids pariétaux thoraciques chez les sujets immunocompétents

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