Abstract
Case presentation: 77-year-old former smoker admitted because of fatigue and abdominal distention. Past medical history positive for two previous hospitalizations for pericardial and pleural effusions (no diagnosis achieved). At admission erythrocyte sedimentation rate was 122 mm per hour. Baseline investigations revealed ascitic, pleural and pericardial effusion. Effusions were tapped: neoplastic cells and acid-fast bacilli (AFB) were not identified, aerobic and mycobacterial culture resulted negative. QuantiFERON TB-Gold test was negative. Total body PET-CT and autoimmunity panel were negative. A neoplastic process was considered the most likely explanation. Before signing off the patient to comfort care, a reassessment was performed and an exposure to tuberculosis during childhood was documented. Because of constrictive pericarditis, pericardiectomy was performed: histologic examination showed chronic pericardial inflammation without granulomas, but Ziehl-Neelsen stain identified AFB and PCR was positive for Mycobacterium tuberculosis complex. Patient was started on anti-TB therapy with resolution of the effusions in the following months. Genes associated with defects in innate immunity were sequences and dentritic cells were studied, but no alterations were identified. Discussion: A Bayesian approach to clinical decision making should be recommended. Interpretation of diagnostic tests should take into account the imperfect diagnostic performance of the majority of these tests. Further studies to investigate genetic susceptibility to tuberculosis are needed.
| Original language | English |
|---|---|
| Pages (from-to) | 88-91 |
| Number of pages | 4 |
| Journal | International Journal of Infectious Diseases |
| Volume | 85 |
| DOIs | |
| Publication status | Published - Aug 1 2019 |
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Keywords
- Bayes
- Diagnostic performance
- Tuberculosis
ASJC Scopus subject areas
- Microbiology (medical)
- Infectious Diseases
Cite this
The hidden hypothesis : A disseminated tuberculosis case. / Foresti, Sergio; Perego, Maria Rita; Carugati, Manuela; Casati, Anna; Malafronte, Cristina; Manzoni, Marco; Badolato, Raffaele; Gori, Andrea; Achilli, Felice.
In: International Journal of Infectious Diseases, Vol. 85, 01.08.2019, p. 88-91.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The hidden hypothesis
T2 - A disseminated tuberculosis case
AU - Foresti, Sergio
AU - Perego, Maria Rita
AU - Carugati, Manuela
AU - Casati, Anna
AU - Malafronte, Cristina
AU - Manzoni, Marco
AU - Badolato, Raffaele
AU - Gori, Andrea
AU - Achilli, Felice
PY - 2019/8/1
Y1 - 2019/8/1
N2 - Case presentation: 77-year-old former smoker admitted because of fatigue and abdominal distention. Past medical history positive for two previous hospitalizations for pericardial and pleural effusions (no diagnosis achieved). At admission erythrocyte sedimentation rate was 122 mm per hour. Baseline investigations revealed ascitic, pleural and pericardial effusion. Effusions were tapped: neoplastic cells and acid-fast bacilli (AFB) were not identified, aerobic and mycobacterial culture resulted negative. QuantiFERON TB-Gold test was negative. Total body PET-CT and autoimmunity panel were negative. A neoplastic process was considered the most likely explanation. Before signing off the patient to comfort care, a reassessment was performed and an exposure to tuberculosis during childhood was documented. Because of constrictive pericarditis, pericardiectomy was performed: histologic examination showed chronic pericardial inflammation without granulomas, but Ziehl-Neelsen stain identified AFB and PCR was positive for Mycobacterium tuberculosis complex. Patient was started on anti-TB therapy with resolution of the effusions in the following months. Genes associated with defects in innate immunity were sequences and dentritic cells were studied, but no alterations were identified. Discussion: A Bayesian approach to clinical decision making should be recommended. Interpretation of diagnostic tests should take into account the imperfect diagnostic performance of the majority of these tests. Further studies to investigate genetic susceptibility to tuberculosis are needed.
AB - Case presentation: 77-year-old former smoker admitted because of fatigue and abdominal distention. Past medical history positive for two previous hospitalizations for pericardial and pleural effusions (no diagnosis achieved). At admission erythrocyte sedimentation rate was 122 mm per hour. Baseline investigations revealed ascitic, pleural and pericardial effusion. Effusions were tapped: neoplastic cells and acid-fast bacilli (AFB) were not identified, aerobic and mycobacterial culture resulted negative. QuantiFERON TB-Gold test was negative. Total body PET-CT and autoimmunity panel were negative. A neoplastic process was considered the most likely explanation. Before signing off the patient to comfort care, a reassessment was performed and an exposure to tuberculosis during childhood was documented. Because of constrictive pericarditis, pericardiectomy was performed: histologic examination showed chronic pericardial inflammation without granulomas, but Ziehl-Neelsen stain identified AFB and PCR was positive for Mycobacterium tuberculosis complex. Patient was started on anti-TB therapy with resolution of the effusions in the following months. Genes associated with defects in innate immunity were sequences and dentritic cells were studied, but no alterations were identified. Discussion: A Bayesian approach to clinical decision making should be recommended. Interpretation of diagnostic tests should take into account the imperfect diagnostic performance of the majority of these tests. Further studies to investigate genetic susceptibility to tuberculosis are needed.
KW - Bayes
KW - Diagnostic performance
KW - Tuberculosis
UR - http://www.scopus.com/inward/record.url?scp=85067200747&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85067200747&partnerID=8YFLogxK
U2 - 10.1016/j.ijid.2019.05.023
DO - 10.1016/j.ijid.2019.05.023
M3 - Article
VL - 85
SP - 88
EP - 91
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
SN - 1201-9712
ER -