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Clinical cases

Skin, ear and testis unusual sites of tuberculosis

Pulmonary localization is the most common site of tuberculosis (TB)and the most contagious form. Extrapulmonary tuberculosis with the rarest and most unexpected localizations represents a significant proportion of all cases of tuberculosis and remains an important public health problem. We report three unusual TB locations: skin, ear and testis occurred in three immunocompetent patients. In the case of skin and testicular lesions, diagnosis was based on pathological confirmation of granulomas with caseous necrosis. In the third case the diagnosis was made possible by identification of positive Acid-Fast Bacilli smear and positive culture from othic drainage fluid. The outcome at all three patients was good with antituberculous treatment. These unusual localization of tuberculosis also highlight the possibility of extrapulmonary tuberculosis as a differential diagnosis in many common diseases.
Keywords: extrapulmonary tuberculosis, immunocompetent host, unusual sites

Williams-Beuren syndrome a rare cause of recurrent hemoptysis

Williams-Beuren syndrome (WBS) is a rare genetic disease with a distinctive constellation of clinical findings. The disease can be diagnosed clinically by a recognizable pattern of malformations, including cardiovascular malformations, a characteristic facial dysmorphism, as well as neurological and cognitive features. We present the case of a 23-years-old woman repeatedly admitted to Pulmonology Clinic for massive hemoptysis. Diagnosis of Williams-Beuren syndrome was revealed by clinical findings and confirmed by CT-angiography data of cardiovascular malformations and fluorescence in situ hybridization (FISH) genetic test. WBS is a multisystem disorder and usually is recognized by clinician. If clinical impression is not clearly consistent with WBS, FISH remains the most widely used test.
Keywords: Williams-Beuren syndrome, hemoptysis

Severe pulmonary arterial hypertension in an adult patient with total anomalous pulmonary venous connection operated in infancy

The goal of total anomalous pulmonary venous connection repair is to obtain an unobstructed communication between the pulmonary veins and the left atrium and removing intracardiac shunting. However, pulmonary venous obstruction or stenosis may be seen in 5-10% of patients, is usually evident in the first 6 months following surgery and may lead to pulmonary congestion, pulmonary arterial hypertension, and late mortality. In such cases, early intervention may be indicated before irreversible secondary changes occur. We present the case and the therapeutic approach of an adolescent patient with total anomalous pulmonary venous drainage to the superior vena cava operated in infancy who developed pulmonary venous obstruction and secondary severe pulmonary arterial hypertension.
Keywords: Total anomalous pulmonary venous connection; pulmonary venous obstruction; surgical repair; pulmonary arterial hypertension

Massive hemoptysis due to intercostal artery aneurysm in pulmonary tuberculosis

Massive hemoptysis is a life-threatening complication of pulmonary tuberculosis. In the presence of pulmonary tuberculosis, massive hemoptysis can result from a number of different causes, with an artery aneurysm being rarely reported. Here we present a case of recurrent massive hemoptysis in a 28-year-old man suffering from active pulmonary tuberculosis due to an aneurysmatic lesion of the second intercostal artery. In patients presented with recurrent massive hemoptysis the non-bronchial systemic arterial blood supply should be assessed.
Keywords: Intercostal artery aneurysm; massive hemoptysis; pulmonary tuberculosis; angiography