Although tuberculosis is a chronic infectious disease that can occur in any section of the body, oral tuberculosis is rare. Here, we report a case of oral tuberculosis in which the patient sought treatment for a painful oral lesion. A histopathologic examination revealed the characteristics of tuberculosis and pulmonary lesions were detected on subsequent examination. The patient was treated with antituberculosis therapy, and his symptoms improved. This case emphasizes the importance of including oral tuberculosis as part of the differential diagnosis for mucosal lesions.
Communicable Diseases ; Diagnosis, Differential ; Humans ; Mouth ; Tuberculosis ; Tuberculosis, Oral

Up to 1937, 357 cases of tongue tuberculosis had been reported. However, Since potent antituberculosis drugs had been introduced, the incidence of oral tuberculosis lesions has been dramatically decreased. This might be related to the marked vascularity of the tongue which enables a high concentration of the drug to be reached to the lesion. Both the primary and secondary types of tuberculosis can be revealed in the oral cavity. In the primary type, the causative organisms are directly inoculated in the oral mucosa of a person who has never been tuberculosis earlier and who has not acquired an immunity to the disease, In the secondary type, tuberculosis of the oral cavity is coexistent with pulmonary disease. We report a case of tongue tuberculosis with pulmonary tuberculosis, with a review of literature.
Humans ; Incidence ; Lung Diseases ; Mouth ; Mouth Mucosa ; Tongue* ; Tuberculosis* ; Tuberculosis, Oral ; Tuberculosis, Pulmonary*

Peliosis hepatis is an uncommon liver condition involving abnormal dilation of hepatic sinusoids, eventually leading to blood-filled cavities within the hepatic parenchyma. Although the pathogenesis is not understood fully, peliosis hepatis has usually been associated with the use of anabolic steroid therapy, oral contraceptives, various malignancies or tuberculosis. We report a case of 59-year-old patient with cholangiocarcinoma with peliosis hepatis. The patient was admitted for evaluation of abdominal pain and fever. Abdomen CT showed a round cytic and solid mass with peripheral duct dilatation in liver. Grossly, the spongy-like solid mass and cyst was noted. Microscopically, the solid mass was composed of tubular and solid adenocarcinoma in fibrotic stroma and a blood-filled cavity with dilated sinusoids was noted.
Abdomen ; Abdominal Pain ; Adenocarcinoma ; Cholangiocarcinoma* ; Contraceptives, Oral ; Dilatation ; Fever ; Humans ; Liver ; Middle Aged ; Peliosis Hepatis* ; Tuberculosis

For the pharmacokinetic analysis of isoniazid transfer into CSF, steady-state isoniazid concentrations of plasma and CSF were measured in eleven tuberculous meningitis patients confirmed with findings of CSF and neuroimazing. Peak plasma levels (4.17-21.5 micrograms/mL) were achieved at 0.25 to 3 hours after multiple isoniazid dose (600 mg/day). Terminal half-life, total clearance (CI/F) and volume of distribution (Vd/F) were 1.42 +/- 0.41 hr, 0.47 +/- 0.22 L/kg/hr and 0.93 +/- 0.48 L/kg, respectively. Isoniazid concentrations in CSF collected intermittently were highest at 3 hr (Mean, 4.18 micrograms/mL) and were 0.54 +/- 0.21 micrograms/mL at 12 hrs after the last dose of isoniazid 10 mg/kg/day. CSF/plasma partitioning of isoniazid and equilibration rate were estimated using modified pharmacokinetic/pharmacodynamic model. Disposition rate constant from CSF to plasma and CSF/plasma partitioning ratio of isoniazid were estimated to be 0.39 h-1 and 1.17, respectively.
Administration, Oral ; Humans ; Isoniazid/*cerebrospinal fluid ; Metabolic Clearance Rate ; Models, Biological ; Tuberculosis, Meningeal/*cerebrospinal fluid

PURPOSE: Idiopathic granulomatous mastitis (GM) is an uncommon breast disease that mimics carcinoma in terms of the clinical and radiological findings. Its unknown etiology makes the management difficult. Although surgical excision with or without steroid therapy has been the mainstay of the treatment, the efficacy of this treatment has been inconsistent. This study was performed to evaluate the diagnostic methods and the treatment outcomes. METHODS: This retrospective study included 31 patients with the diagnosis of GM and 4 patients had bilateral disease. They were found from the database of the pathology laboratory at Cheil General Hospital between January 1999 and December 2004. We reviewed the clinical, radiological, and pathological information, and we finally evaluated the treatment outcomes according to the surgical and medical treatments. RESULTS: The mean age at diagnosis was 34.2 years (range: 27~57). All the patients were parous except one, and 82% of patients were within 5 years from their last delivery. Four patients had bilateral involvement. Only three patients used oral contraceptives and 54% of patients had a history of breast feeding. Most patients (91%) presented with mass and the remainder (9%) presented with fistula. The confirmative diagnosis was made by FNAB (fine needle aspiration biopsy), debridement, CNB (core needle biopsy) or excision. Surgical excision or debridement was successful in 13 cases (39.4%) of 33 cases. Anti-tuberculosis medications were successful in 85% (11/13). Steroid treatment was successful in only two patients (29%). CONCLUSION: Surgical excision provided not only the definite diagnosis, but also treatment of GM for the cases in which a clear surgical margin was obtained. Anti-tuberculosis medication can be considered if fistula or abscess is intractable after excision, even with failure to identify tuberculosis.
Abscess ; Breast Diseases ; Breast Feeding ; Contraceptives, Oral ; Debridement ; Diagnosis* ; Fistula ; Granulomatous Mastitis* ; Hospitals, General ; Humans ; Needles ; Pathology ; Retrospective Studies ; Treatment Outcome* ; Tuberculosis

Gold preparation had been used frequently in the past in the treatment of rheumatoid arthritis, tuberculosis and lupus erythematosua, etc. It is still used. when other more potent remedies, such as steroid, failed. We report a case of drug eruption following the use of gold preparation. A 38 year-old female was referred to our department from orthopedic surgery because of generalized, multiple, pin head sized, violaceous and flat topped papules of 1 x 2 mm in size and mucosal erosions and ulcers following gold therapy for rheumatoid arthritis. She had received 5 intramuscular injections of gold preparation (Myochrysine'), 220mg in total amounts. Our clinical impression was lichen planus like drug eruption, but histopathological picture disclosed nonapecific dermatitis. The eruption had disappeared gradually following oral administration of antihistaminics and prednisolone and daily starch tub baths.
Administration, Oral ; Adult ; Arthritis, Rheumatoid ; Baths ; Dermatitis ; Drug Eruptions* ; Female ; Head ; Humans ; Injections, Intramuscular ; Lichen Planus ; Orthopedics ; Prednisolone ; Starch ; Tuberculosis ; Ulcer

Atopic dermatitis (AD) is a common inflammatory skin disorder mediated by inflammatory cells, such as macrophages and mast cells. Rifampicin is mainly used for the treatment of tuberculosis. Recently, it was reported that rifampicin has anti-inflammatory and immune-suppressive activities. In this study, we investigated the effect of rifampicin on atopic dermatitis in vivo and in vitro. AD was induced by treatment with 2, 4-dinitrochlorobenzene (DNCB) in NC/Nga mice. A subset of mice was then treated with rifampicin by oral administration. The severity score and scratching behavior were alleviated in the rifampicin-treated group. Serum immunoglobulin E (IgE) and interleukin-4 (IL-4) levels were also ameliorated in mice treated with rifampicin. We next examined whether rifampicin has anti-atopic activity via suppression of mast cell activation. Rifampicin suppressed the release of β-hexosaminidase and histamine from human mast cell (HMC)-1 cultures stimulated with compound 48/80. Treatment with rifampicin also inhibited secretion of inflammatory mediators, such tumor necrosis factor-α (TNF-α) and prostaglandin D₂ (PGD₂), in mast cells activated by compound 48/80. The mRNA expression of cyclooxygenase 2 (COX-2) was reduced in the cells treated with rifampicin in a concentration-dependent manner. These results suggest that rifampicin can be used to treat atopic dermatitis.
Administration, Oral ; Animals ; Cyclooxygenase 2 ; Dermatitis, Atopic ; Histamine ; Humans ; Immunoglobulin E ; Immunoglobulins ; In Vitro Techniques* ; Interleukin-4 ; Macrophages ; Mast Cells ; Mice ; Necrosis ; Rifampin* ; RNA, Messenger ; Skin ; Tuberculosis

Atopic dermatitis (AD) is a common inflammatory skin disorder mediated by inflammatory cells, such as macrophages and mast cells. Rifampicin is mainly used for the treatment of tuberculosis. Recently, it was reported that rifampicin has anti-inflammatory and immune-suppressive activities. In this study, we investigated the effect of rifampicin on atopic dermatitis in vivo and in vitro. AD was induced by treatment with 2, 4-dinitrochlorobenzene (DNCB) in NC/Nga mice. A subset of mice was then treated with rifampicin by oral administration. The severity score and scratching behavior were alleviated in the rifampicin-treated group. Serum immunoglobulin E (IgE) and interleukin-4 (IL-4) levels were also ameliorated in mice treated with rifampicin. We next examined whether rifampicin has anti-atopic activity via suppression of mast cell activation. Rifampicin suppressed the release of β-hexosaminidase and histamine from human mast cell (HMC)-1 cultures stimulated with compound 48/80. Treatment with rifampicin also inhibited secretion of inflammatory mediators, such tumor necrosis factor-α (TNF-α) and prostaglandin D₂ (PGD₂), in mast cells activated by compound 48/80. The mRNA expression of cyclooxygenase 2 (COX-2) was reduced in the cells treated with rifampicin in a concentration-dependent manner. These results suggest that rifampicin can be used to treat atopic dermatitis.
Administration, Oral ; Animals ; Cyclooxygenase 2 ; Dermatitis, Atopic ; Histamine ; Humans ; Immunoglobulin E ; Immunoglobulins ; In Vitro Techniques* ; Interleukin-4 ; Macrophages ; Mast Cells ; Mice ; Necrosis ; Rifampin* ; RNA, Messenger ; Skin ; Tuberculosis

Rifampin is commonly used as a first-line anti-tuberculosis drug, but it can induce a serum sickness-like reaction or anaphylaxis. However, it is possible for 1 drug antigen to induce 2 or more simultaneous immunologic reactions. Here, we report a case of a serum-sickness-like reaction and anaphylaxis induced concurrently by rifampin. A 25-year-old male presented with high fever and a maculopapular rash with vesicles on the hands, which developed 2 weeks following regular administration of anti-tuberculosis drugs for tuberculous meningitis, including rifampin. Elevated liver enzymes, peripheral neuropathy, and decreased serum C3 and C4 levels were found. Interestingly, these symptoms were accompanied by severe hypotension. A serum-sickness-like reaction was considered after excluding other potential causes for the fever. A drug provocation test showed that the fever developed after oral administration of rifampin, suggesting that rifampin was the cause of the allergic reaction. However, hypotension, epigastric discomfort, and diarrhea also accompanied these symptoms, indicating that IgE-mediated type I hypersensitivity could be part of the serum sickness-like reaction. An intradermal skin test clearly showed an immediate positive reaction to rifampin. This case was diagnosed as concurrent serum-sickness-like reaction and anaphylaxis induced by rifampin. One drug may therefore induce combined allergic reactions via 2 or more simultaneous hypersensitivity responses.
Administration, Oral ; Adult ; Anaphylaxis* ; Diarrhea ; Exanthema ; Fever ; Hand ; Humans ; Hypersensitivity ; Hypersensitivity, Immediate ; Hypotension ; Liver ; Male ; Peripheral Nervous System Diseases ; Rifampin* ; Skin Tests ; Tuberculosis, Meningeal

Breast tuberculosis is a rare form of tuberculosis (TB). In healthy individuals in developed countries, the incidence is <0.1% of breast lesions examined histologically. The significance of breast TB is due to its rare occurrence and mistaken identity with breast cancer or pyogenic breast abscess. We report the case of an 18-year-old healthy woman diagnosed with breast TB that mimicked breast abscess. She was admitted for multiple erythema nodosum (EN) of the lower extremities of 6 weeks duration. She also noticed a painful oral ulcer and a palpable nodule with fistula on the right breast for 8 weeks. Our patient had the characteristic radiological and histopathological features of breast TB. Breast abscess and EN improved after antitubercular medication, including isoniazid, rifampin, ethambutol and pyrazinamide.
Abscess ; Adolescent ; Breast ; Breast Neoplasms ; Developed Countries ; Erythema Nodosum ; Ethambutol ; Female ; Fistula ; Humans ; Incidence ; Isoniazid ; Lower Extremity ; Oral Ulcer ; Pyrazinamide ; Rifampin ; Tuberculosis