Respircase Cilt: 6 - Sayı: 1 Yıl: 2017

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Respiratory Case Reports medical treatment alone is applied. In case of alveolar echinocous, the curative medical treatment is surgery. Early diagnosis is important for the chance of resection, as it is a disease which processes biologically malignant. In Turkey, the disease is usually diagnosed at an advanced stage, and mortality is a result of widespread disease. There are speculative opinions on the utility of chemotherapy; however, it is recommended that the lesion should be re-evaluated for resection in nonresectable lesions after chemotherapy (5-7). In our case, who was asymptomatic, curative surgery was planned, as E. alveolaris was diagnosed after wedge resection. Left re-thoracotomy and upper lobe wedge resection was performed. In the biopsy specimen nodular structures, as well as cystic structures coated with a painted cuticle material, were detected. Pathologically, E. alveolaris and granulosus co-existence was considered. In the literature, there is only one case of co-existent E. granulosus and alveolaris in the liver (8); however, this is the first case of co-existent E. alveolaris and E. granulosus in the lung. In patients with cavitating nodular lesions, echinococcal infections must be kept in mind in Turkey where echinococcus is still endemic. Early diagnosis and treatment are essential. Although rare, co-existence of E. alveolaris and E. granulosus infections can be seen. CONFLICTS OF INTEREST None declared. AUTHOR CONTRIBUTIONS Concept - B.A.Ö., Y.E., S.B.Ö., F.D., H.E.Ö., E.G.; Planning and Design - B.A.Ö., Y.E., S.B.Ö., F.D., H.E.Ö., E.G.; Supervision - B.A.Ö., Y.E., S.B.Ö., F.D., H.E.Ö., E.G.; Funding - B.A.Ö., Y.E.; Materials - B.A.Ö., Y.E.; Data Collection and/or Processing - B.A.Ö., Y.E.; Analysis and/or Interpretation - B.A.Ö., Y.E.; Literature Review - B.A.Ö.; Writing - B.A.Ö.; Critical Review - B.A.Ö. YAZAR KATKILARI Fikir - B.A.Ö., Y.E., S.B.Ö., F.D., H.E.Ö., E.G.; Tasarım ve Dizayn - B.A.Ö., Y.E., S.B.Ö., F.D., H.E.Ö., E.G.; Denetleme - B.A.Ö., Y.E., S.B.Ö., F.D., H.E.Ö., E.G.; Kaynaklar - B.A.Ö., Y.E.; Malzemeler - B.A.Ö., Y.E.; Veri Toplama ve/veya İşleme - B.A.Ö., Y.E.; Analiz ve/veya Yorum - B.A.Ö., Y.E.; Literatür Taraması - B.A.Ö.; Yazıyı Yazan - B.A.Ö.; Eleştirel İnceleme - B.A.Ö. REFERENCES 1. Craig PS, McManus DP, Lightowlers MW, Chabalgoity JA, Garcia HH, Gavidia CM, et al. Prevention and control of cystic echinococcosis. Lancet Infect Dis 2007; 7:385-94. [CrossRef] 2. Aytaç A, Yurdakul Y, İkizler C, Olga R, Saylam A. Pulmonary hidatid disease: report of 100 patients. Ann Thorac Surg 1977; 23:145-51. 3. Gündoğdu C, Arslan R, Arslan MÖ, Gıcık Y. Evaluation of cystic and alveolar echinococcosis cases in people in Erzurum and surrounding cities. Türkiye Parazitoloji Dergisi, 2005; 29:163-6. 4. Özin Y, Kılıç ZM, Parlak E, Kaçar S, Turhan N, Şaşmaz N, Şahin B. Hepatik echinococcus multilocularis: olgu sunum ve literatürün gözden geçirilmesi. Akademik Gastroenteroloji Dergisi 2008; 7:106-10. 5. Wilson JF, Rausch RL. Alveolar hydatid disease: a review of clinical features of 33 indigenous cases of Echinococcus multilocularis infection in Alaskan Eskimos. Am J Trop Med Hyg 1980; 29:1340-55. 6. Amman RW. Improvement of liver resectional therapy by adjuvant chemotherapy in alveolar hydatid disease. Parasitol Res 1991; 77:290-3. [CrossRef] 7. Gillet M, Miguet JP, Mantion G, Bresson-Hadni S, Becker MC, Rouget C, et al. Orthotopic liver transplantation in alveolar echinococcosis of the liver: analysis of a series of six patients. Transplant Proc 1988; 20(! Suppl 1):573- 6. 8. Etlik Ö, Ünal Ö, Uygan İ, Bay A, Temizöz O, Sakarya ME. Coincidence of Echinococcus alveolaris and granulosis infections in the same liver. Eur J Gen Med 2004; 1:58- 9. Cilt - Vol. 6 Sayı - No. 1 44
RESPIRATORY CASE REPORTS Respir Case Rep 2017;6(1):45-47 DOI: 10.5505/respircase.2017.75436 OLGU SUNUMU CASE REPORT HIV Seronegatif Hastada Parasternal Tüberküloz ve İnsidental Abdominal Kitle Parasternal Tuberculosis and Incidental Abdominal Mass in an HIV Seronegative Patient Deniz Kızılırmak 1 , Müjgan Zuhal Güler 2 , Ebru Ünsal 3 , Filiz Çimen 2 , Nermin Çapan 2 Özet Yumuşak doku tüberkülozu nadir görülen akciğer dışı tüberküloz formudur. Özellikle primer akciğer tüberkülozunun eşlik etmediği durumlarda klinik olarak malignite ile karışabilmektedir. Olgumuz, HIV seronegatif, 39 yaşında bir bayan hastadır. Sternum ön kısmında ele gelen şişlik şikâyeti olan hastaya kitle rezeksiyonu yapılmış ve patolojisi kazeifiye granülomatöz inflamasyon olarak raporlanmıştır. Hastaya ‘yeni olgu akciğer dışı tüberküloz’ tanısıyla dörtlü anti-TB tedavi başlandı. Fizik muayenesinde sağ alt kadran hassasiyeti saptanan hastanın abdomen ultrasonunda ve tomografisinde sağ alt kadranda kitle lezyonu görüldü. Gastroenteroloji tarafından kolonoskopide; çıkan kolonda, biyopsi sonrasında pürülan bir akıntının boşaldığı kitle görüldü. Hastanın patoloji raporu granülomatöz nekroz olarak yorumlandı. Yumuşak doku tüberkülozu tanısı ile takip edilen hastaya, eşlik eden gastrointestinal tüberküloz tanısı konuldu ve hastanın tedavi süresi 9 ay olarak uzatıldı. Tüberküloz nedeni ile takip edilen hastalarda, sistem sorguları ve fizik muayeneleri, başka bir tüberküloz odağının belirtisini de ortaya çıkarabilmektedir. Olgumuzda eşlik eden gastrointestinal tüberküloz tanısı nedeni ile tedavi süresi uzamıştır. Anahtar Sözcükler: Akciğer dışı tüberküloz, abdominal, kitle. Abstract Soft tissue tuberculosis is a rare form of extrapulmonary tuberculosis. It can be clinically confused with malignancy, particularly in cases without accompaniment of primary pulmonary tuberculosis. A 39-yearold female, HIV-seronegative patient was admitted with a complaint of a palpable swelling in front of the sternum. After surgical resection, the pathological result was reported as granulomatous inflammation. The patient was diagnosed with extrapulmonary tuberculosis, and anti-tuberculosis treatment was started. She had tenderness in the right lower quadrant on physical examination. Ultrasound and tomography scans showed a 6x5 cm mass in the right lower quadrant. Colonoscopy revealed a mass on the ascending colon, in which purulent discharge after biopsy was reported. Its pathology result was reported as granulomatous necrosis. We diagnosed the patient with soft tissue tuberculosis with concomitant gastrointestinal tuberculosis. She received treatment for nine months. Key words: Extrapulmonary tuberculosis, abdominal, mass. 1 Turgut Özal Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, Ankara 2 Atatürk Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi, Göğüs Hastalıkları Anabilim Dalı, Ankara 3 Yıldırım Beyazıt Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, Ankara 1 Department of Pulmonary Diseases, Turgut Özal University Faculty of Medicine, Ankara, Turkey 2 Department of Pulmonary Diseases, Atatürk Chest Diseases and Chest Surgery Education and Training Hospital, Ankara, Turkey 3 Department of Pulmonary Diseases, Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey Başvuru tarihi (Submitted): 25.04.2016 Kabul tarihi (Accepted): 11.07.2016 İletişim (Correspondence): Ebru Ünsal, Yıldırım Beyazıt Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, Ankara e-mail: unsalebru73@yahoo.com 45
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