Tuberculosis of the axial skeleton mimicking malignancy

Multifocal bony lesions involving vertebral bodies and cancellous bones commonly occur in metastases and haematological malignancies. However, tuberculosis being a ‘great mimic’, can have a similar presentation. We present a young Indian female who had bony lesions involving multiple cancellous bones, without constitutional features. Extensive search for a neoplastic cause revealed negative results. Histopathological examination of the involved tissue revealed diagnosis of tuberculosis, which was not suspected. The patient improved remarkably with antitubercular therapy.

Tuberculous bronchoesophageal fistula managed conservatively with a percutaneous gastrostomy for feeding and administration of medication

Bronchoesophageal fistulae are a rare complication of tuberculosis. Traditionally they are managed by either thoracotomy with resection and closure of the fistulous tract or by taking a more conservative approach of giving standard treatment for tuberculosis while ensuring nutritional support through a nasogastric tube. We report a young student with disseminated tuberculosis complicated by a bronchoesophageal fistula. He was managed conservatively with anti-tuberculous chemotherapy and nutrition administered through a percutaneous endoscopic gastrostomy tube.

The impact of new national HIV testing guidelines at a district general hospital in an area of high HIV seroprevalence

The latest UK national human immunodeficiency virus (HIV) testing guidelines, released in September 2008, state that HIV testing should be offered to all patients with indicator conditions and considered in all general medical admissions in high-prevalence areas. We audited testing rates at Blackpool Victoria Hospital, a high-prevalence area, one year before and one year after the publication of the new guidelines. In the year after publication the rate of HIV testing in patients with indicator diseases was as follows: hepatitis B 6%, hepatitis

Pyothorax-associated lymphoma – the first reported case in the UK

An 84-year-old man presented with dyspnoea and chest pain, together with a chest X-ray demonstrating a complete white-out of the left hemithorax. Four decades earlier he had been treated for tuberculosis with an artificial pneumothorax. A diagnosis of pyothorax-associated lymphoma (exclusively B-cell non-Hodgkin’s type) was made. Strongly associated with Epstein-Barr virus infection, pyothorax-associated lymphoma is known to develop in the chronic inflammatory environment of a pleural cavity in patients with a long-standing history of pyothorax.

The importance of pursuing a histological diagnosis in the hiv setting

A 40-year-old heterosexual African man was admitted with fever, night sweats and lymphadenopathy. His human immunodeficiency virus antibody test was positive. Initial lymph node biopsy revealed reactive hyperplasia only. He was empirically treated for tuberculosis. However, symptoms persisted and a repeat lymph node biopsy was obtained, which confirmed Hodgkin’s disease. This emphasises the need to pursue histological diagnosis in such patients with persisting symptoms.

Keywords  HIV, Hodgkin’s disease, lymphadenopathy, tuberculosis

Significant resolution of tuberculous pleural effusion on chemotherapy alone

Background: As a standard, significant pleural effusion, whether tuberculous (TB) or not, requires therapeutic thoracocentesis. We tested the hypothesis that standard anti-TB chemotherapy alone can resolve significant pleural effusion.

Methods: 20 eligible patients with TB pleural effusion of at least 30% of the hemithorax (10 with moderate-size and 10 with large-size effusion, respectively) were retrospectively reviewed for radiological resolution of their effusions at two, six and 12 months after commencement of standard six-month therapy.

Cannabis and the lung

The use of cannabis is embedded within many societies, mostly used by the young and widely perceived to be safe. Increasing concern regarding the potential for cannabis to cause mental health effects has dominated cannabis research and the potential adverse respiratory effects have received relatively little attention.