Tuberculosis of the breast with erythema nodosum: a case report

<p>Abstract</p> <p>Introduction</p> <p>There has been an increasing number of tuberculosis cases worldwide, but tuberculosis of the breast remains rare. In rare cases this is seen with a cutaneous manifestation of erythema nodosum.</p> <p>Case presentation</p> <p>We report the case of a 33-year-old Chinese woman with tuberculosis of the left breast accompanied by erythema nodosum on the anterior aspect of both lower legs. Due to her poor clinical response to conventional therapy, and the histopathological findings of fine needle aspiration cytology, there were strong indications of tuberculosis. Her clinical diagnosis was confirmed by molecular detection of <it>Mycobacterium tuberculosis </it>complex by polymerase chain reaction. The diagnosis was further confirmed by a second polymerase chain reaction test of erythema nodosum which tested positive for <it>Mycobacterium tuberculosis</it> complex. She received anti-tuberculous therapy for 18 months, and finally underwent residual lumpectomy. During her follow-up examination after 12 months, no evidence of either residual or recurrent disease was present.</p> <p>Conclusion</p> <p>Histopathological features and a high index of clinical suspicion are necessary to confirm a diagnosis of tuberculosis of the breast. Anti-tuberculous therapy with or without simple surgical intervention is the core treatment.</p

African Tick Bite Fever

Physicians may encounter unfamiliar diseases as a result of international travel. Fever with rash is an important sign that usually represents initial manifestation of infectious disorders. A 62-year-old Taiwanese woman presented with multiple eschars, a papulovesicular rash, and fever 5 days after returning from South Africa. A biopsy specimen of an eschar had wedge-shaped tissue necrosis, hemorrhage, necrotizing vasculitis of the small venules and arterioles, and a dense perivascular lymphocytic infiltrate in the dermis. Serologically, there was cross reaction with both Rickettsia conorii and R. rickettsii. DNA sequencing demonstrated R. africae, confirming the diagnosis of African tick bite fever. The patient responded well to minocycline. Recognition of the symptoms and signs, and diagnostic tools for different types of rickettsiosis are essential for correct diagnosis and treatment