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Tuberculosis – an old disease in elderly patients
Dendooven M, Van Couter A, Roeland P, Van Hoeyweghen R
Two patients were admitted on a geriatric ward with general symptoms and tuberculosis was diagnosed. The atypical presentation of disease and the lack of accurate diagnostic tests are highlighted in this report.
The first patient had a chronic lower tract respiratory infection, fever, weight loss and was treated with antibiotics and steroids. ESR en CRP were elevated. Radiology and CT scan of the chest indicated and inflammatory process. Mantoux test was negative. Direct investigation of sputum was positive as was the PCR test for mycobacteria.
The second patient had suffered tuberculosis during the second world war and had received an iatrogenic pneumothorax as treatment. He presented with fever, weight loss, transpiration during night time and depression. ESR was elevated. CT scan of the chest was suggestive for an abcedation in the pleura. Bence Jones proteinuria was positive. Bone marrow investigation allowed to exclude B cell lymphoma but showed 2 epithelo?d granuloma with giant cells of the Langhans type. Direct investigation and culture of the bone marrow was negative as was the PCR test on mycobacteria.
Both patients were treated with tuberculostatic drugs and clinical improvement was evident.
Both cases illustrate the atypical presentation of disease, the high rate of falls negative diagnostic tests and the potential curative effect of treatment.
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