Tuberculosis presenting as stridor

A 40-year-old woman was seen with stridor and mediastinal widening secondary to tuberculous mediastinal lymphadenopathy mimicking neoplasm. Initially, stridor could only be controlled with high-dose corticosteroids, but following initiation of antituberculous chemotherapy corticosteroids were withdrawn successfully and the mediastinal lymphadenopathy resolved.     

Tuberculosis presenting as carpal tunnel syndrome

A 44-year-old man presented with typical symptoms, signs, and laboratory findings of carpal tunnel syndrome. Mycobacterium tuberculosis was cultured from the flexor tenosynovium excised at surgery. Tuberculosis should be considered in the differential diagnosis of carpal tunnel syndrome with unexplained chronic synovitis. The diagnosis may be missed unless a tissue specimen is analyzed specifically with acid-fast stain and culture. Therapy should include excision of involved synovium, early postoperative mobilization, and appropriate chemotherapy.     

Treatment of superior sulcus tumor (Pancoast tumor)

It appears that combined preoperative radiation and surgery continue to offer the best survival results in patients with superior sulcus tumors. Patients with involvement of the brachial plexus, Horner's syndrome, rib invasion, and ipsilateral neck node metastases are still candidates for combined modality therapy, with expectations of survival of about 30 to 40 per cent. However, those presenting with invasion of vertebrae, involvement of subclavian vessels, and mediastinal lymph node metastases do poorly. In this latter group, treatment by high-dose external radiation alone may prove to be as effective as combined modality treatment.     

Tuberculosis of epididymis and testicle presenting as hydrocele

An eighty-four-year-old man had an enlarging, tender hydrocele. Hydrocelectomy was performed, and the pathologic report showed caseating granulomas. Ten days later the patient underwent an orchiectomy. Microscoipic sections showed multiple foci of caseous necrosis, multinucleated giant cells, and acid fast bacilli. A search for other foci of tuberculosis was nonproductive.     

Pulmonary metastatic giant cell tumors presenting as totally hyalinized and ossified nodules

We report a case of giant cell tumor of the left distal femur with simultaneous bilateral pulmonary metastases. Pathologic examination of the left lung nodule showed a metastatic giant cell tumor with a noncontinuous ossified rim, and the right lung nodules were totally hyalinized or ossified without residual giant cell tumor components. Hyalinization was a consistent finding in both the primary bone lesion and the pulmonary metastases. Because the patient did not receive chemotherapy or radiotherapy before her surgical procedure, we believe that these changes represent spontaneous tumor regression.     

Malignant melanoma presenting as renal tumor

We present a case of malignant melanoma presenting as a large renal mass and mimicking renal cell carcinoma. The literature on genitourinary melanoma is reviewed.     

Tuberculosis of the sternum presenting as metastatic disease.

The case is presented of a 59 year old Saudi Arabian woman with sternal and vertebral tuberculous osteomyelitis and a benign breast mass simulating metastatic disease. This case illustrates the diagnostic difficulties that may be encountered in the diagnosis of tuberculous osteomyelitis.     

Tuberculosis of the penis presenting as a subcutaneous nodule

We report a case of tuberculosis of the penis that presented as a subcutaneous nodule without superficial ulceration.     

Tuberculosis presenting as acute hepatitis in a renal transplant recipient

We observed a kidney transplant recipient in whom acute hepatitis was the initial manifestation of tuberculosis, preceding radiological lung involvement by several weeks. The diagnosis was suspected and treatment initiated based on the finding of a granulomatous hepatitis on liver biopsy. Mycobacterial, tuberulosis was grown and identified first in liver samples and only later in sputum and bone marrow. This case illustrates the protean manifestations of tuberculosis in immunosuppressed patients.     

Tuberculosis with secondary vasculitis presenting as a nasal septal perforation

A 45 years old man with tuberculosis (TB) and secondary vasculitis presented with perforation of the nasal septum, involving skin and cranial nerves. Vasculitis is a recognized, tough rare complication of tuberculosis and has not been previously described in the literature as a cause of nasal septal perforation. It presents a diagnostic dilemma. The diagnostic challenges of this case are outlined, and the clinical implications are discussed.