PMID- 26046019
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20150605
LR  - 20201001
IS  - 2249-782X (Print)
IS  - 0973-709X (Electronic)
IS  - 0973-709X (Linking)
VI  - 9
IP  - 4
DP  - 2015 Apr
TI  - Treatment paradox in musculo-skeletal tuberculosis in an immunocompetent adult 
      male; a case report from a tertiary care hospital.
PG  - DD01-2
LID - 10.7860/JCDR/2015/10943.5749 [doi]
AB  - Paradoxical reactions like immune reconstitution inflammatory syndrome (IRIS) as 
      seen with patients on retroviral treatment in HIV infection, have also been 
      identified in HIV sero-negative patients with extra pulmonary tuberculosis 
      especially lymph-node tuberculosis. Musculo-skeletal tuberculosis presenting as a 
      cold abscess of the anterior chest wall is a rare entity which poses diagnostic 
      and therapeutic challenge. A 35-year-old immunocompetent male came with complains 
      of painless lump on right side of his chest over 9th and 10th intercostal space 
      which gradually increased and extended upto 11th rib area. Clinically, diagnosis 
      of cold abscess was made and anti-tubercular therapy (ATT) was started. Despite 
      of being on ATT for 3 weeks, patient developed pain and signs of inflammation. 
      Fluid was aspirated and sent for biochemical and microbiological investigations. 
      The aspirated fluid was positive for acid fast bacilli by ZN stain and grew 
      Mycobacterium tuberculosis in culture, sensitive to first line ATT. Pyogenic and 
      fungal culture was negative. This case presented as an anterior chest wall cold 
      abscess which deteriorated on initiation of first line ATT, thus creating a 
      suspicion of resistance to ATT which was cleared on ATT susceptibility testing. 
      Hence, this case underlines the possibility of treatment paradoxes seen in 
      immunocompetent musculo-skeletal tuberculosis.
FAU - Chaskar, Priyanka
AU  - Chaskar P
AD  - Senior Resident, Department of Microbiology, P.G.I.M.E.R & Dr. R.M.L. Hospital , 
      New Delhi, India .
FAU - Rana, Geetika
AU  - Rana G
AD  - Post-Graduate, Department of Microbiology, P.G.I.M.E.R & Dr. R.M.L. Hospital , 
      New Delhi, India .
FAU - Anuradha
AU  - Anuradha
AD  - Assistant Professor, Department of Microbiology, P.G.I.M.E.R & Dr. R.M.L. 
      Hospital , New Delhi, India .
FAU - Duggal, Nandini
AU  - Duggal N
AD  - Consultant and Professor, Department of Microbiology, P.G.I.M.E.R & Dr. R.M.L. 
      Hospital , New Delhi, India .
FAU - Arora, Jyoti
AU  - Arora J
AD  - Microbiologist, Department of Microbiology, National Institute of Tuberculosis 
      and Respiratory Diseases , New Delhi, India .
LA  - eng
PT  - Case Reports
DEP - 20150401
PL  - India
TA  - J Clin Diagn Res
JT  - Journal of clinical and diagnostic research : JCDR
JID - 101488993
PMC - PMC4437066
OTO - NOTNLM
OT  - Anterior chest wall
OT  - Cold abscess
OT  - Paradox
OT  - Tuberculous
EDAT- 2015/06/06 06:00
MHDA- 2015/06/06 06:01
PMCR- 2015/04/01
CRDT- 2015/06/06 06:00
PHST- 2014/08/24 00:00 [received]
PHST- 2015/01/27 00:00 [accepted]
PHST- 2015/06/06 06:00 [entrez]
PHST- 2015/06/06 06:00 [pubmed]
PHST- 2015/06/06 06:01 [medline]
PHST- 2015/04/01 00:00 [pmc-release]
AID - 10.7860/JCDR/2015/10943.5749 [doi]
PST - ppublish
SO  - J Clin Diagn Res. 2015 Apr;9(4):DD01-2. doi: 10.7860/JCDR/2015/10943.5749. Epub 
      2015 Apr 1.