Acta Scientific Neurology (ASNE) (ISSN: 2582-1121)

Case Report Volume 7 Issue 2

Fatal Multi-Organ Vasculitis with Mycosis Masquerading as Tuberculosis in an Adolescent Male

Bishakha Deb1*, Vivek Kharolkar2, Vikas Maindad3, Buddheshwar Narayan Hiwale4, Pritisha Chaudhary1, Priyanka Palve4 and Shwetambari Thakare2

1Junior Resident, Department of Pathology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
2Assistant Professor, Department of Pathology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
3Associate Professor, Department of Pathology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
4Professor and Head, Department of Pathology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India

*Corresponding Author: Bishakha Deb, Junior Resident, Department of Pathology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India

Received: November 29, 2023; Published: January 30, 2024

Abstract

Background: Introduction: Multi-organ vasculitis is known to be an inflammation affecting vessels of various calibres either in response to an immune mediated event or an infection. It is known to affect virtually all organs including the pulmonary vasculature most commonly, gastrointestinal system, urogenital system and the central nervous system.

Case Description: A 15 – year old male presented with symptoms of nasal swelling which gradually grew to involve the periorbital region along with cervical lymphadenopathy. The physical examination and laboratory investigations were within normal limits. Contrast enhanced computerised tomography revealed features suggestive of an infective etiology favouring osteomyelitis. Corticosteroids were instated to control the inflammation. However the absence of response prompted further investigation. Fine needle aspiration cytology was performed which was suggestive of an inflammatory pathology of the region. This prompted histopathological studies of the lymph node and soft tissue from the mass revealing multiple ill-formed granulomas with multinucleate giant cells and fibrosis and micro abscesses consisting of karyorrhectic debris surrounded by lymphocytes, plasma cells and histiocytes with vasculitis. Ziehl-Neelsen stain for acid-fast bacilli were negative. The final diagnosis was necrotizing granulomatous lymphadenopathy with the differentials of tuberculosis being favoured over Kikuchi’s disease. Pulmonary consult indicated the institution of antituberculosis treatment. By day 19 of admission, the patient became febrile, disoriented and demonstrated aggressive behaviour. Medical and psychiatric evaluation suggested maxillary sinus osteomyelitis, with a suspicion of central nervous system (CNS) tuberculosis. Magnetic resonance imaging (MRI) revealed multifocal non-haemorrhagic infarct secondary to embolic shower, possibly secondary to tuberculosis. On day 23, he succumbed to his illness. A medical post mortem was performed following which the histopathological and microbiological studies lead to the final diagnosis of widespread vasculitis with mycosis involving the cerebrum, lungs and parotid glands.

Conclusion: The widespread occurrence of tuberculosis along with its various atypical presentation make it the most common diagnosis considered in our demographic set up. This case highlights the importance of giving equal weightage to other entities, including the spectrum of immunological illnesses such as vasculitis and other infectious agents in order to improve prognostic outcomes.

Keywords: Fatal; Multi-Organ; Vasculitis; Tuberculosis; Adolescent Male

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    Citation

    Citation: Bishakha Deb.,et al. “Fatal Multi-Organ Vasculitis with Mycosis Masquerading as Tuberculosis in an Adolescent Male". Acta Scientific Neurology 7.2 (2024): 41-45.

    Copyright

    Copyright: © 2024 Bishakha Deb., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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