Tuberculosis infection remains an important cause of mortality. The clinical and radiological manifestations can be non-specific and resemble many other conditions, including malignancies. This could lead to diagnostic delay. We report the case of a 48-year-old woman with tuberculosis presenting with a right upper lobe mass manifesting as metastatic lung cancer. She also had liver cirrhosis secondary to chronic hepatitis B infection. She developed hepatitis two weeks into her tuberculosis treatment. Our case highlights the importance of considering tuberculosis in patients suspected to have underlying malignancy and to be aware of the potential adverse effects of treatment.
Lung Neoplasm ; Neoplasms ; Antitubercular Agents

Paradoxical response refers to the enlargement of old lesions or unexpected appearance of new lesions after initial improvement following treatment with antitubercular agents. Various types of paradoxical responses have been reported in the world, but they are rarely reported in Korean children. We report the case of a 17-year-old boy who was diagnosed with tuberculous pleurisy and was treated appropriately. Although the tuberculous pleurisy initially responded to medication with resolution of the pleural fluid, a new pulmonary lesion subsequently developed 3 weeks after the initiation of treatment that eventually cleared with continuation of the original drug regimen.
Adolescent ; Antitubercular Agents ; Child ; Humans ; Tuberculosis, Pleural

BACKGROUND: A paradoxical response is defined as the radiological and clinical worsening of a previous lesion or the development of new lesion after initial improvement during theprocess of antituberculous treatment. The related factors for the development of a paradoxical response in patients with tuberculous pleurisy are not certain. METHODS: We selected patients with tuberculous pleurisy who had been treated for more than 4 months. The changes onthe serial chest X-ray findings before and after treatment were reviewed. Paradoxical responses were regarded as any worsening or development of new lesion at least 2 weeks after the initiation of treatment. The baseline clinical characteristics and laboratory findings of the peripheral blood and pleural fluid were compared between the patients with a paradoxical response and the patients without a paradoxical response. RESULTS: Paradoxical responses appeared in sixteen patients (21%) among the 77 patients.It took a mean of 38.6 days after the treatment and the time to resolve the paradoxical response was a mean of 32.1 days. For the patients with a paradoxical response, the median age was younger (30.5 years vs 39.0 years, respectively) and the lymphocytic percentage of white blood cells in the pleural fluid was higher (82.1% vs 69.6%, respectively) than for the patients without a paradoxical response. CONCLUSION: The development of a paradoxical response during the treatment of patients with tuberculous pleurisy was not rare and this was related with the age of the patients and the percentage of lymphocytic white blood cells in the pleural fluid.
Antitubercular Agents ; Humans ; Leukocytes ; Thorax ; Tuberculosis, Pleural

Antitubercular Agents/therapeutic use* ; Axilla ; Humans

Antitubercular Agents ; standards ; Child ; Humans ; Tuberculosis ; drug therapy ; prevention & control

Pyrazinamide (PZA) is one of the most important drugs for the treatment of Mycobacterium tuberculosis infection. However, the increasing frequency of PZA-resistant strains limits its effectiveness. In Korea, most PZA-resistant strains also exhibit both isoniazid and rifampin resistance making it essential to identify these resistant strains accurately and rapidly for effective treatment of mycobacterial infection. In this study, the characteristics and frequency of mutations of the pncA gene encoding pyrazinamidase were investigated in PZA-resistant clinical isolates from Korea. Automated DNA sequencing was used to evaluate the usefulness of DNA-based detection of PZA resistance. Among 95 PZA-resistant clinical isolates, 92 (97%) exhibited mutations potentially affecting either the production or the activity of the enzyme. Mutations were found throughout the pncA gene including the upstream region. Single nucleotide replacement appeared to be the major mutational event (69/92), although multiple substitutions as well as insertion and deletion of nucleotides were also identified. The high frequency of pncA mutations observed in this study supports the usefulness of DNA-based detection of PZA-resistant M. tuberculosis. Having verified the scattered and diverse mutational characteristics of the pncA gene, automated DNA sequencing seems to be the best strategy for rapid detection of PZA-resistant M. tuberculosis.
Amidohydrolases/*genetics ; Antitubercular Agents/*pharmacology ; Drug Resistance, Bacterial ; *Mutation ; Mycobacterium tuberculosis/*drug effects/genetics ; Pyrazinamide/*pharmacology

Tuberculosis of the breast is a rare disease. Its diagnosis is difficult because clinical and radiological appearances are not specific and because isolation of the tubercle bacillus from the lesion is seldom possible. This disease is more common in women between 20 to 40 years of age, but is rare in male, elderly patients and prepubertal women. Difinite diagnosis rests on bacterilogical proof and histopathological findings -formation of a granuloma and usually caseous necrosis with or without demonstrable acid-fast bacilli. Treatment of the disease requires a combination of surgery and antitubercular drugs. We experienced 10 cases of tuberculosis of the breast and report with on them along a literature review.
Aged ; Antitubercular Agents ; Bacillus ; Breast* ; Diagnosis ; Female ; Granuloma ; Humans ; Male ; Necrosis ; Rare Diseases ; Tuberculosis*

Anti-tuberculosis drugs can produce levels of hepatotoxicity ranging from mild elevation of aminotransferase to severe acute hepatitis. A few cases of drug-induced autoimmune hepatitis or the drug reaction with eosinophilia and systemic symptom (DRESS) syndrome by anti-tuberculosis medications have been reported. However, concomitant occurrence of these two disorders has not been reported. Here, we present a case of severe acute hepatitis with DRESS syndrome and autoimmune hepatitis resulting from primary standard anti-tuberculosis drugs. Both conditions were successfully treated with a systemic steroid regimen.
Antitubercular Agents ; Drug Hypersensitivity Syndrome ; Eosinophilia* ; Ethambutol* ; Hepatitis ; Hepatitis, Autoimmune* ; Isoniazid*

Adult ; Antitubercular Agents ; adverse effects ; Humans ; Isoniazid ; adverse effects ; Male ; Pulmonary Fibrosis ; chemically induced ; diagnosis

BACKGROUNDDrug susceptibility assay is very important in tuberculosis therapy. Pyrazinamide is a first line antituberculosis drug and diagnosis of its resistance in Mycobacterium tuberculosis (M. tuberculosis) is difficult and time consuming by conventional methods. In this study, we aimed to evaluate the performance of the microscopic observation drug susceptibility (MODS) assay in the detection of pyrazinamide resistance in M. tuberculosis relative to the conventional Wayne assay and Lowenstein-Jensen (LJ) proportion method.

METHODSM. tuberculosis clinical isolates (n = 132) were tested by the MODS and the Wayne assay: the results were compared with those obtained by the LJ proportion method. Mutations in the gene were identified by direct sequencing of the pncA genes of all isolates in which pyrazinamide resistance was detected by any of the three methods.

RESULTSCompared to the LJ results, the sensitivity and specificity of the MODS assay were 97.8% and 96.5% respectively; the sensitivity and specificity of the Wayne assay were 87.0% and 97.7% respectively. Mutations in the pncA gene were found in 41 of 46 strains that were pyrazinamide resistant (3 tests), in 1 of the 4 strains (LJ only), in 42 of 48 strains (at least 1 test), but no mutations in 1 strain sensitive according to the MODS assay only. The MODS assay, Wayne assay and LJ proportion method provided results in a median time of 6, 7 and 26 days respectively.

CONCLUSIONSMODS assay offers a rapid, simple and reliable method for the detection of pyrazinamide resistance in M. tuberculosis and is an optimal alternative method in resource limited countries.