Tuberculous vesico-vaginal fistula.

A 32-year-old female with a past history of pulmonary tuberculosis presenting with dribbling of urine per vaginam had a small fistulous opening in the anterior vaginal wall. Chest X-ray showed active tuberculosis. Right hydronephrosis and hydroureter with autonephrectomy of left kidney and vesico-vaginal fistula were demonstrated on intravenous urography. On cystoscopy, the bladder was contracted with two small fistulous openings. Cecocystoplasty and repair of fistulae were successfully done. Histology of bladder wall showed tuberculous cystitis.     

A Woman with Tuberculous Meningitis Peripartum

A fatal case of basal tuberculous meningitis occurring in the peripartum period is presented. The elusiveness of the diagnosis, despite invasive studies, emphasizes the need to maintain a high level of clinical suspicion based on the patient’s demographic characteristics and the lack of response to conventional therapy.     

Pericardial effusion,right-sided pleural effusion and ascites associated with stage IV endometriosis. A case report

BACKGROUND: Endometriosis has rarely been associated with ascites and less often with pleural (usually right-sided) effusion. CASE: A multiparous, reproductive-aged woman was referred for evaluation of possible ovarian carcinoma following the development of dyspnea, progressive abdominal distention, weight loss and increasing secondary dysmenorrhea. Imaging demonstrated normal ovaries in the presence of massive ascites and right-sided pleural and pericardial effusions. At laparotomy, grade IV endometriosis was noted. Total abdominal hysterectomy, bilateral salpingo-oophorectomy and appendectomy were performed, with subsequent resolution of all cavity fluid accumulations. CONCLUSION: Pericardial and pleural effusions in the presence of ascites may be associated with endometriosis.     

Tuberculous synovitis of the elbow joint.

Tuberculous synovitis in the elbow joint is extremely rare in developed countries. We describe a 68-year-old man who had had a gradually enlarging mass over the volar side of the left proximal forearm near the elbow joint for 4 months. Plain roentgenograms of the diseased elbow showed early osteoarthritic change. Magnetic resonance imaging revealed diffuse synovitis with a large 8 x 8 cm extra-articular synovial cyst. Synovectomy was performed and histopathologic examination of the surgical specimen revealed granulomatous inflammation with caseation, prominent Langhan's giant cells, and sparse acid-fast bacilli. The patient had been receiving antituberculous chemotherapy for at least 8 months at the time of examination and had no recurrence of swelling or discharging sinuses during follow-up. Differential diagnoses in patients with elbow swelling should include pigmented villonodular synovitis, hemophilic arthropathy, rheumatoid arthritis, degenerative joint disease, and tuberculosis. Simple aspiration may enable earlier diagnosis, before destructive arthropathy becomes advanced.     

Pleural effusion in aneuploidy.

Three consecutive cases of isolated pleural effusion in aneuploid fetuses are reported. The presence of pleural effusion in trisomy 13 had not been described in the literature previously. Early development of pleural effusion is usually associated with fetal hydrops and carries a poor prognosis. Late development of pleural effusion can be treated in utero. A karyotype should be performed in all cases of pleural effusion prior to in utero pleuroamniotic shunting.     

Tuberculous meningitis in a Filipino maid.

Tuberculous meningitis, while not uncommon in Taiwan, has not been reported among foreign workers. We report the first case of tuberculous meningitis in a 37-year-old Filipino maid in Taiwan, who presented with headache, fever and vomiting. She had been well before this episode and the small screening films of the chest radiograph obtained on her arrival in Taiwan 15 months previously, and every 6 months thereafter showed no evidence of tuberculosis. The suspicion of tuberculous meningitis was delayed until disturbance of consciousness manifested and a standard chest radiograph showed a diffuse miliary pattern in both lung fields. A cerebrospinal fluid sample that was sent for a polymerase chain reaction-based assay specific for Mycobacterium tuberculosis showed a positive result. The patient recovered with sequelae of mildly incoherent speech and urinary incontinence after antituberculous medication and short-course steroid treatment. Clinicians should be aware of the possibility of tuberculous meningitis in foreign workers with complaints of fever and headache. Because high-quality chest radiographs are a prerequisite for early detection of pulmonary tuberculosis, we recommended that standard posterior-anterior chest radiographs should be obtained as part of the routine health examination for foreign workers.