AN ATYPICAL TUBERCLUSIS IN PATIENT HEMODIALYSIS: A case report

AN ATYPICAL TUBERCLUSIS IN PATIENT HEMODIALYSIS: A case report


Authors:

Taziki, Omolbanin, Abolghasemi, Rozita, Amirpour, Anahita Department internal medicine of Shohada Tajrish Hospital,Shahid Beheshti University of Medical Sciences

Correspondence:

taziki66@yahoo.com

AN ATYPICAL   TUBERCLUSIS   IN PATIENT   HEMODIALYSIS: A   case report

Introduction : Although   over one billion people suffer from tuberculosis world wide . mammary   tuberculosis is an extremely   rare condition. Its prevalence has been estimated to be 0.1 %of breast lesions   examind   histologically, and it constitutes about 3- 4.5 % of surgically -treated breast diseases   in developing countries. Among patients with chronic renal failure requiring replacement   therapy   , rate of TB   10-25 fold greater than those in general population have been reported from   United States , Canada , Europe ,and Japan , equaling to incidence rate of approximately 250 case per 100,000 per year.

Case Report :

A 31-year old woman known case of ESRD due diabetes mellitus who was on the regular hemodialysis program three time per week. She presented with left sided chest wall pain since 20 day ago.

Past medical history : IDDM (16 yr ) ,ESRD (4 yr ), Cholecystetomy ( 7 months ago ).she used folic acid , enalapril, caco3 ,ASA , and erythropoietin .

Vital sign were stable . lab test were listed in table 1 . On physical examination her left breast was swellen ,with tenderness and fluctuation , without erythema and warmness. Examination of respiratory system was normal , the abdomen was soft ,with out organomegally or tenderness , and there was no palpable peripheral lymphadenopathy .

chest X-Ray was remarkable calcific lymphnode in inferior lobe superior segment of left lung were seen on high resolution CT of the chest . Small collection of fluid in upper part of breast was seen in ultrasonography.

She received antibiotic (boared expectrom ), then suffered a surgery for breast   abcess. In gross pathology was extensive collection of pus and cheese   like necrotic tissue. Mycobacterium tuberculosis was seen in Ziehe-Neelsen acid fast stain culture in Bac-Tec medium from the pus of breast. Standared anti-TB therapy   with Isoniazid ,Rifampin ,Pyrazinamide , and Ethambutol was administered for patient .patient symptoms resolved after one month of therapy .

Dicussion : Breast tuberculosis is an extremely rare condition .in area of TB endemicity , the relative risk attributable to chronic renal failure requiring dialysis appear to be similar. Diabetes mellitus appears to be associated with TB in patients with renal renal failure . Extrapulmonary involvement of mycobacterium infection is more frequent than isolated pulmonary involvement in ESRD patients possibility due to impaired cellular immunity in such patients, but   diagnosis and treatment present an important problem.