Search

Tuberculosis (TB) is the major problem being faced worldwide, particularly in developing countries, and therefore, it is important to recognize the unusual presentations of the disease. Although TB is primarily lung disease, it can affect several other organs such as bone, brain, liver, and intestine etc. Liver involvement in TB is not uncommon but isolated liver TB is the rarest form of TB. A common observation is that the mortality rate is higher in intra-abdominal TB as compared to pulmonary TB, but it is a difficult diagnosis to make, often requiring laparotomy. Liver tuberculoma is, in particular, rare, with fewer than 100 cases reported in the literature, most of which are secondary and associated with miliary TB. We present a case of primary hepatic tuberculoma in an immuno-competent host and illustrate how these cases can be managed non-surgically.

Neurofibromatosis type 2 is a genetic autosomal dominant disorder, caused by spontaneous mutation in the gene located on chromosome 22 q11-13.1,which usually emerges in adolescence or early adulthood and is characterized by development of bilateral vestibular schwannoma. We hereby report the classical case of Neurofibromatosis type 2 in a 25 years old young male with multiple tumors associated with the disease.This patient presented to us with 3 years history of multiple painless nodules on his skin, facial weakness , left sided progressive hearing loss and 20 days history of weakness in the left lower limb. On Examination he was vitally with a GCS of 15/15. He was anemic with no jaundice. He had left inguinal lymphadenopathy along with multiple subcutaneous nodules on different areas including the scalp, face, left mid axillary line over the abdomen.He also had Right sided facial palsy and horizontal nystagmus. CNS examination revealed upgoing plantar on left side, right facial nerve palsy and bilateral vestibulocochlear nerve paralysis. Spine examination revealed spinal tenderness in the lower lumbar region.Superficial abdominal reflexes were absent. Upper limb and right lower limb power, tone and reflexes were normal while the tone and power in the left lower limb was reduced power being ⅗. Reflexes were also exaggerated in the left lower limb. The right ankle showed swelling most probably a plexiform neuroma. On investigations he had normochromic normocytic anemia with mild leucocytosis. Platelets were normal. Rest of the biochemical investigations including serum electrolytes, liver function tests and renal function tests were also normal.MRI brain and spine confirmed bilateral accoustic neuroma and multiple cranial and peripheral nerves tumors i.e classical presentation of a rare disease neurofibromatosis.He was referred to neurology unit for further assesment and treatment.

Echinococcus cystic infection is a zoonotic infection caused by the larval stage of cestode species belonging to the genus Echinococcus. Through the modulation of the immune system by this parasite, there is an established link of this infection with the metastasis and progression of a tumor. We present a case of a patient with synchronous findings of metastatic adenocarcinoma with unknown primary along with the previous history of echinococcal infection which highlights the need of prompt management of such infections with a regular follow up of such patients.