ABSTRACT Background : Tuberculosis (TB) is still major worldwide concern especially at tropical country. Tuberculosis also can infect any place in the body. It is estimated that between 10-25% of TB infections occur extra pulmonary. Abdominal Tuberculosis occurs about 10 % of extra pulmonary tuberculosis. Abdominal Tuberculosis can be easily confused with malignancy. Pseudo Meigs syndrome is co existence of pelvic tumour, hydrothorax, and ascites. It is resembles with metastatic ovarian cancer. Abdominal tuberculosis may resemble with advanced ovarian cancer. Case Report: A married woman, 21 years old, with chief complaint enlargement stomach since 2 weeks before come to the hospital. Patient also had poor intake, low-grade fever, pelvic pain. Cough , weight loss, defecation disturbance, urinated disturbance, enlargement another area were denied. Family history, her father was diagnosed tuberculosis on treatment. Ascites was presented. Thorax X ray found right effusion plural . Complete blood count, albumin, electrolyte serum, renal function test, liver function test were at normal limit. Hepatitis Viral marker were negative. Peritoneal Fluid Analysis found elevated LDH (905 U/L), elevated PMN count 1050/ uL, MN count 3829/ uL, Glucose 68 mg/dL, Protein 7.2 g/dL, SAAG 0.8 mg/dl. ADA test from effusion pleural 4,44 U/L ( within normal limit). A significantly elevated CA-125 level ( 542.5 U/mL). Contrast MSCT abdominal found cyctic lesion with septal and multiple peritumoral lymph node suspected malignant ovarian mass. Laparotomy was done and found serous ascites, multiple nodules attached to the surface of bilateral uterus ½ centimeters and attached to bilateral ovary, and dense adhesions between uterus and rectum. Multiple biopsies were done. Finally, histopathology investigation revealed multinucleated giant cell ( Datia Langhans) with necrotizing granulomatous changes with no malignant cells in all biopsies. Acid fast stain tuberculosis was positive at paraffin block pathology. The patient got anti tuberculosis drugs. After 2 months treatment, patient feel better and there was no complaint enlargement stomach. Until now the patient is on treatment. Discussion The patient presented ascites, pleural effusion, cystic ovarian suggestive of Pseudo-Meigs syndrome. Pseudo Meigs Syndrome is clinically important because resembling of metastatic pelvic cancer. CA-125 is elevated 80% of post menopausal ovarian cancer but not specific and non diagnostic in premenopausal women. SAAG < 1.1 mg / dl indicates non Portal hypertension, caused by infection, malignancy, nephrotic syndrome, or pancreatitis. Finding Datia Langhans at histopathology could be considered as tuberculosis but it can be revealed from another disease. Acid fast stain positive increase the probability of tuberculosis infection. Family history of tuberculosis infection could increase diagnostics value of tuberculosis. Antituberculosis according to the latest protocol led to clinical improvement. Conclusion: Extra Pulmonary Tuberculosis (TB) should be being considered in the differential diagnosis of advanced ovarian cancer, especially in the regions that are endemic for the disease. Keywords : ovarian tuberculosis , peritoneal tuberculosis, tuberculosis
My name is Mona Ebadian and I am currently the dermatology Registrar working in Northampton General Hospital. I have graduated from UCL in 2009 and completed my core medical training in 2015. I am now working as a dermatology registrar and me and my colleagues would like to share our interesting dermatological case which dramatically improved during pregnancy.
We present a case of a 40-year-old female with four years history of widespread rash which had disappeared during her pregnancy and breast feeding period. It reoccurred after breastfeeding was stopped. Her past medical history included IVF, during this time her skin changes remained unchanged. Physical examination showed widespread flat-topped papules 1-2mm in diameter, more prominent on the extensor surfaces of the forearms and trunk. Laboratory tests showed normal FBC, liver and renal function. LDH was within normal level. Autoimmune screen ANA, DsDNA and ENA were negative. Incisional biopsies showed superficial dermal lymphocytic infiltrate and foreign body type granulomas abutting the basal layer of the epidermis. There were no features of eczema, cutaneous T cell lymphoma or keratosis pilaris. The histology was consistent with lichen nitidus. Lichen nitidus is a rare inflammatory skin eruption of unknown cause, which usually affects the upper extremities. The generalised form is even more uncommon. Often no treatment is required and the condition can be self-limiting. To our knowledge there is no previous report of exact cause of Lichen nitidus. There is previous reports that during pregnancy, many women experience remission of autoimmune diseases like multiple sclerosis and uveitis. The pathophysiology is still not well understood, although we know that during pregnancy part of the immune system is downgraded in favour of the growing fetus. As this patients’ skin had completely cleared during pregnancy and breast feeding, we suggest that possibly there may be similar pathophysiology of autoimmune origin involved in Lichen nitidus.