Our study findings underscore the diagnostic superiority of enrichment culture and/or PCR over conventional microbiological culture for improved case detection of melioidosis from non-blood clinical specimens.
Isolated epididymo-orchitis is an unusual presentation of tuberculosis. A case of bilateral epididymitis and right-sided orchitis with scrotal involvement in a 38-year-old male patient is presented. Strong clinical suspicion of tuberculous etiology was confirmed by appropriate investigations of epididymal biopsy. The patient improved clinically with antitubercular therapy.
Primary tubercular psoas abscess is a rare clinical entity and has seldom been reported in an otherwise healthy person. Here we report an interesting case of primary tubercular psoas abscess in an immunocompetent male with no other traceable source. Case reportA 35-year-old male ayurvedic doctor was admitted to a tertiary care hospital with complaints of pain associated with movements in the left hip joint, low-grade persisting fever, progressive loss of appetite, and loss of weight for the last six months. Chest examination was within normal limits and there was no lymphadenopathy. The patient had a history of cholecystectomy two years earlier. There was no past or family history of tuberculosis, hypertension, or diabetes mellitus. He was earlier treated for enteric fever due to significant Widal titre levels and the fever subsided. Meanwhile the patient travelled to Kuwait for a month, where he again had fever and was treated with paracetamol for fever and diclofenac ointment for hip pain. As he returned to India, Brucella agglutination test revealed a significant titre of 1:320. The patient was treated with doxycycline and rifampicin for 10 days by a local physician. The Brucella agglutination test was repeated after treatment and the titre was found to be 1:160, whereas erythrocyte sedimentation rate was 120 mm at the end of the first hour. Peripheral blood smear revealed hypochromic microcytic anaemia with neutrophilia and thrombocytosis. The patient was further continued with intravenous paracetamol and doxycycline. However, fever was still persistent despite treatment and the patient stopped working. As there was no improvement, he was admitted to our tertiary care hospital. On examination, blood tests showed HBsAg positive for hepatitis B and raised Creactive protein (88.1mg/L). Titres for the Brucella agglutination test and widal test were negative. Blood and urine cultures were sterile. Other serological tests for HIV, antinuclear antibody, rheumatoid factor and HBcAg were negative. Ultrasonography of the abdomen indicated mild splenomegaly. Echocardiogram was normal. A bone marrow trephine biopsy was performed and sent for histopathology; however, it was not possible to form a conclusion because of the inadequate sample size. Bone marrow culture yielded a growth of Pseudomonas spp., which was probably an environmental contaminant. Technetium-99 m bone scan did not show any hot spots in the spine ( Figure 1). Magnetic resonance imaging of the hip joint (done outside) indicated inflammatory changes in the ala of the sacrum on left with a large collection in the left iliopsoas muscle and pre sacral space communicating with the gluteal region through the sciatic notch suggestive of abscess (Figures 2A and 2B). Repeated ultrasonography indicated loculated fluid (approximately 540 ml) collection with internal septations involving the left iliacus and psoas muscle measuring 25 x 6.7 x 6 cm and extending up to the insertion of the iliopsoas muscle.The left iliopsoas abscess was drained by open later...
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