Tuberculosi1 - Peritoneal TB may mimic ovarian cancer or...

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Tuberculosis 2. Extrapulmonary TB One general feature of extrapulmonary TB is that AFB (acid-fast bacilli) are scanty, compared to cavitary TB. AFB are often not seen on biopsy or grown on culture, so the diagnosis is often presumptive, based on the clinical syndrome, presence of granulomas on biopsy, and PPD positivity. Only about 50% of patients with extrapulmonary TB have simultaneous active pulmonary TB. Although TB may affect any organ, some extrapulmonary presentations are characteristic. Cervical lymphadenitis (scrofula): painless lymph node swelling in the neck; may lead to purulent drainage; less than 20% are systemically ill; more common in women by a 2:1 ratio (pulmonary TB somewhat more common in men); PPD usually strongly positive. Renal TB: suspect in patients with sterile pyuria and renal calcification; dysuria and hematuria common; most are afebrile.
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Unformatted text preview: Peritoneal TB: may mimic ovarian cancer, or carcinomatous peritonitis, with numerous peritoneal implants; may occur in “wet” or “dry” forms (with or without ascites); diagnosis may be missed in alcoholics. Very low yield of peritoneal fluid AFB stains, diagnosis usually made by biopsy of implants. Meningeal TB: subacute onset of fever and headache in adults; lymphocytic pleocytosis in CSF; basilar meningitis with cranial nerve palsies. TB in the CNS may also present as a ring-enhancing cerebral mass lesion (“tuberculoma”). Vertebral TB (Pott’s disease of the spine): usually affects thoracic spine, perhaps because of lymphatic drainage from chest; associated with large paravertebral “cold” abscess, which may track along the psoas muscle. May result in severe spinal deformity (as in the poet Alexander Pope)....
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