Title: Overdiagnosis of drug Resistant EPTB (Thyroid)
Authors: Nirmal Chandra Satpathy, Pravati Dutta, Rekha Manjhi, Sudarsan Pothal, Aurobindo Behera, Gourahari Pradhan
DOI: https://dx.doi.org/10.18535/jmscr/v8i2.31
Abstract
Introduction: Tuberculosis of thyroid gland is extremely uncommon. The incidence is low even in countries where the prevalence of tuberculosis is high. Objective of this case report is to present a case of over-diagnosed thyroid tuberculosis and to discuss its clinical presentation, investigations, observations and management.
Case Presentation: A 38-year old female presented to Pulmonary Medicine department (Tertiary care hospital) with a 6 months history of slowly progressive neck swelling, weakness and loss of appetite. On examination there was a firm swelling over neck of size 3cm x 4cm. There was no previous history of tuberculosis.
Investigation: Chest radiograph showed no abnormality, sputum smear was found negative for AFB, Mantoux test with 5TU revealed an in duration of 12mm. Thyroid profile was normal. FNAC of thyroid swelling was suggesting granulomatous thyroiditis. Biopsy of thyroid swelling was suggesting autoimmune thyroiditis. CBNAAT of Biopsy specimen of Thyroid revealed MTB detected and Rifampicin resistant. At the same time liquid culture of that biopsy specimen of thyroid was done and later found to be negative.
Observation: The case was found to be over diagnosed as DR Thyroid TB. This case was referred to DR-TB Centre VIMSAR for initiation of DR-TB Regimen. But no ATT was given and kept under observation. Follow-up examination after two months showed resolutions of signs and symptoms.
Conclusion: Thyroid tuberculosis is rare form of tuberculosis. So patient not exposed to TB or any contact history of DR-TB patient should be judiciously treated to prevent overdiagnosis.
Keywords: Thyroid tuberculosis, Extra-pulmonary Tuberculosis, CBNAAT.
References
- Mondal A and Patra D K, "Efficacy of fine needle aspiration cytology in the diagnosis of tuberculosis of thyroid gland" a study of 18 cases," Journal of Laryngology and Otology, vol. 109, no.1, pp. 36-38, 1995.
- W. Rankin and A. S. Graham, “Tuberculosis of the thyroid gland,” Annuals of Surgery, vol. 96, no. 4, pp. 625–648, 1932.
- Das DK, Pant CS, Chachra KL, Gupta AK. Fine needle aspiration cytology diagnosis of tuberculous thyroiditis: a report of eight cases. Acta Cytol. 1992;36:517–522.
- Van Rie A, Page-Shipp L, Scott L, Sanne !,Stevens W. Xpert (R) MTB/RIF for point-of-care diagnosis of TB IN High-HIV burden, resource-l imited countries: hype or hope? Expert Rev Mal Diagn. 2010; 10(7):937-46.
- Barnard DA, lrusen EM, Bruwer JW, Plekker D, Whitelaw AC, Deetlefs JD, et al. Koegelenberg The utility of Xpert MTB/RIF performed on bronchial washings obtained in patients with suspected pulmonary tuberculosis in a high prevalence setting. BMC Pulm Med. 2015;15:103.