Bangladesh Journal of Medicine最新文献

{"title":"A 40-year-old male with recurrent oro-genital ulceration and joint pain","authors":"Pavel Chowdhury, Md Abul Kalam Azad, Kazi Ali Aftab","doi":"10.3329/bjm.v35i20.73467","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73467","url":null,"abstract":"Bechet’s disease is a systemic inflammatory disorder of unknown aetiology. Early proper diagnosis and treatment is of paramount importance as disease course and management protocol varies among the possibilities. Here, we are reporting a young patient without co-morbidity, who has been labelled as Bechet’s disease after a long journey with diagnostic uncertainty and managed accordingly with positive outcome. Mr. X, 40-year-old male construction worker without any co-morbidities presented with the complaints of multiple recurrent painful, non-itchy, non-discharging oro-genital ulcer along withasymmetrical multiple inflammatory joint pain predominantly involving large joint of lower limbs for 5 years which is more frequent in last 1 year. In addition to above mentioned features, he had mechanical type of low back pain for last 3-4 years. Moreover, he gave history of bilateral painless red eye with blurring of vision for the last 7 months. Furthermore, he complained of significant weight loss for last 1 month. He denied any history of fever, skin rash, alopecia, photosensitivity, dysuria, bowel complaints or any contact to TB patient. Ironically, he visited multiple tertiary level hospital several times over last 5 years and underwent several investigations including skin biopsy and then, he was prescribed anti-TB medications for ulcer as well as methotrexate, sulfasalazine, hydroxychloroquine and NSAID for arthritis but was found inadequate response. On examination, pustular lesions over right tendoachilis and under surface of tongue, a healing ulcer in subcutaneous injection site; a left sided well-defined, firm, tender and irregularly indurated erythematous exudative as well as non-discharging buccal ulcer and of course a painful scrotal ulcer were found. Additionally, he had features of bilateral inflammatory knee joint arthritis and hypopion on eye examination with positive pathergy test. His investigations illustrated microcytic hypochromic anaemia on PBF with increased level of CRP (102) and positive MT, ANA (neocleoli pattern), ENA (SS-A/Ro-52KD), HLA-B27; whereas, synovial fluid showed increased WBC with predominant lymphocytes and negative Gene-Xpert testing. It should be noted that, his HLA-B51, RA, Anti-CCP, Anti-dsDNA, Anti-phospholipid Ab, VDRL, TPHA, HIV, HBsAg, Anti-HCV were negative. Nevertheless, his Ultrasonogram of both knee revealed synovitis and osteophytes; scrotal ulcer biopsy showed chronic non-specific ulcer, endoscopy and colonoscopy was normal. Lastly, his MRI of L/S spine and SI joints showed only degenerative changes without any features of sacroiliitis.Our patient was diagnosed with Bechet’s disease (by fulfilling ISGDx criteria), therefore, he was commenced on methotrexate 15mg OD and colchicine 0.6mg OD for systemic features and topical steroid for mucocutaneous ulcers. Unfortunately, his treatment response was unsatisfactory even after 6 months of continuation. Eventually, azathioprine 50mg BD instead of MTX was ini","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"73 s313","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141376578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BCR-ABL kinase domain mutation analysis in chronic myeloid leukemia patients treated with tyrosine kinase inhibitors.","authors":"Alamgir Kabir","doi":"10.3329/bjm.v35i20.73432","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73432","url":null,"abstract":"Mutations in the Bcr-Abl kinase domain may cause, or contribute to, resistance to tyrosine kinase inhibitors (TKIs) in chronic myeloid leukemia patients. Over the last decade, intensive efforts have been spent in the characterization of the biologic and clinical significance of these mutations on one hand and in the development of novel inhibitors retaining efficacy against as many Bcr-Abl mutant forms as possible on the other hand. The knowledge of the Bcr-Abl KD mutation status is a valuable piece of information to be integrated in the decision algorithm aimed at tailoring the best therapeutic strategy for each of these patients: increasing imatinib dose, switching to the second-generation TKIs dasatinib or nilotinib, then to the third generation Bosutinib or ponatinib moving to allogeneic stem cell transplantation. BCR-ABL KD mutation analysis is not recommended in newly diagnosed chronic phase (CP) patients. Conversely, it can be performed in the rare cases who are in accelerated phase or blast crisis (BC) at the time of imatinib start. Mutation analysis is recommended both in case of failure and in case of suboptimal response to imatinib from a clinical standpoint, “failure” means that continuing a specific treatment is no longer appropriate because a favorable outcome is unlikely. Suboptimal response” means that the patient may still have a substantial long-term benefit from continuing a specific treatment, but the chances of an optimal outcome are reduced. During second-line dasatinib or nilotinib therapy in case of hematologic or cytogenetic failure BCR-ABL KD mutation analysis is recommended. In case of a T315I mutation, which is highly resistant to imatinib, dasatinib, and nilotinib, most appropriate alternative therapeutic option is ponatinib. In case of V299L, T315A, or F317L/V/I/C mutations, nilotinib is probably more effective than dasatinib. In case of Y253H, E255K/V, or F359V/C/I mutations, dasatinib is probably more effective than nilotinib. In case of any other mutation, dasatinib and nilotinib are likely to be similarly effective.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 165","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"9 32","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141378642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid Analgesics in Palliative Care","authors":"Mostofa Kamal Chowdhury","doi":"10.3329/bjm.v35i20.73341","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73341","url":null,"abstract":"Opioid analgesics are essential in palliative care, providing significant pain relief for patients with advanced illnesses or at the end of life. These medications are administered via various routes, including oral, transdermal, subcutaneous, and intravenous, and doses are carefully adjusted to achieve optimal pain control while minimizing side effects such as constipation, nausea, sedation, and respiratory depression. Despite the risks, with proper monitoring, opioids can safely enhance patients' quality of life in palliative care, complemented by psychosocial interventions to address holistic needs. Opioid rotation is a key strategy in managing pain when current opioids provide inadequate relief or cause intolerable side effects. This involves switching to an alternative opioid or adjusting the dose to optimize pain management while minimizing adverse effects. Successful opioid rotation requires careful assessment, monitoring, and collaboration among healthcare professionals. In Bangladesh, the opioid crisis differs from many Western countries, characterized by limited access to essential opioids like morphine rather than widespread abuse. Bureaucratic hurdles, lack of financial incentives for pharmaceutical companies, and insufficient demand due to \"opiophobia\" among physicians create significant barriers. Regulatory challenges, stigma, and limited availability result in inadequate pain relief for terminally ill patients, causing unnecessary suffering. Addressing these issues necessitates comprehensive strategies, including policy reforms to improve opioid access, education to combat stigma, and prioritizing palliative care within healthcare systems. Ensuring adequate access to opioids is crucial for upholding the dignity and comfort of those facing terminal illnesses, enabling them to receive the essential pain relief they deserve.\u0000Bangladesh J Medicine, 2024; Vol. 35, No. 2, Supplementation: 146-147","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"28 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141379717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 60 year old female with redness of eye turns to periorbital swelling with nasal bleeding","authors":"Sharmin Akter","doi":"10.3329/bjm.v35i20.73456","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73456","url":null,"abstract":"Mrs. X, 60 year old hypertensive , diabetic, known case of CKD, non-asthmatic patient came to PMCH with the complaints of redness left eye with left sided orbital swelling. She was reasonably well 15 days back, then suddenly she developed headache followed by redness, swelling with pain on left eye . She went for an eye consultation and took antibiotic eye drop and Oral antibiotic . But after taking medication she didn’t improved at all, eventually swelling and redness extended into right eye as well .She got admitted on NIKDU with orbital complaints. But she had an episode of tinge bleeding per nose and no improvement on orbital complaints . At late night she got admission on PMCH and had an another episode of severe epistaxis which was sudden onset and the amount was about 2-3 tea spoon full . On next day amount was profuse, about ½ cup full. At the same time, she developed bluish to whitish discoloration of skin over nasal area.On examination, she was ill looking, mildly anaemic, tinge bleeding per nose. Her vitais normal. Examination of nervous system reveled partial ptosis of left eye with 3,4,6 nerve palsy with mild ophthalmoplegia, movement of eyes were mildly restricted and No sign of papilledema present. Normal higher psychic function and intact other cranial nerves. Motor function and sensory function was normal and all reflexes were intact .Examination of other system was unremarkable.Histopathology report : Nasal tissue Aspergillosis ª% Sino-nasal tissue Mucormycosis.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 171-172\u0000 ","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141378247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2023 Bangladesh Rheumatology Society (BRS) Rheumatoid Arthritis Management Recommendations: What is new?","authors":"Muhammad Shoaib Momen Majumder, A. T. M. T. Hasan, Minhaj Rahim Choudhury, Md. Titu Miah, Md. Robed Amin, A. Shahin, Syed Atiqul Haq","doi":"10.3329/bjm.v35i20.73504","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73504","url":null,"abstract":"Rheumatoid arthritis (RA) is the most common inflammatory polyarthritis in Bangladesh. The management recommendations for patients with rheumatoid arthritis (RA) is the first initiative in Bangladesh by the Bangladesh Rheumatology Society (BRS) and an updated contribution following a paradigm shift in the management of RA. These recommendations encompass the most crucial elements in treating rheumatoid arthritis, particularly in a country where infection, including tuberculosis, is prevalent, but the resources are limited. BRS established a task force (TF) consisting of four rheumatologists. The task group conducted a comprehensive search for all relevant literature, including the latest ACR, EULAR, APLAR, and other guidelines and systematic literature reviews up until October 2023. A steering committee was established, comprising rheumatologists and internists. We adhered to the EULAR standard operating procedures for classifying levels of evidence and assigning grades to recommendations. This recommendation consists of two components: a general section that includes the diagnosis of rheumatoid arthritis, the nomenclature of disease-modifying antirheumatic drugs (DMARDs), and disease activity indexes; and a therapy section. The task team reached a consensus on four fundamental principles and twelve recommendations. Overarching themes encompass the identification of diseases at an early stage and the ongoing monitoring of disease activity. Recommendations 1-5 propose the utilization of glucocorticoids, NSAIDs, and conventional synthetic DMARDs (csDMARD) as treatment options. Recommendations 6-9 expand the utilization of targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) and biological diseasemodifying antirheumatic drugs (bDMARDs). The recommended treatment for rheumatoid arthritis involves starting with methotrexate (MTX) or another conventional synthetic disease-modifying antirheumatic drug (csDMARD) if MTX is not suitable. This is done in the initial phase. A targeted synthetic DMARD (tsDMARD) is added in the second phase. In later phases, moving to a different tsDMARD or a biologic DMARD (bDMARD) may be necessary. Recommendations 10-12 pertain to the screening of infections, administration of vaccines, and the gradual reduction of disease-modifying antirheumatic drugs (DMARDs). Due to the cost-benefit analysis, BRS has suggested using targeted synthetic disease-modifying antirheumatic medicines (tsDMARDs) in the second phase and biologics in the third phase. The use of the Padua Prediction Score is advised to evaluate the likelihood of vascular thromboembolism in persons who are taking or undergoing dose escalation of tsDMARDs. Bangladesh has a higher prevalence of RA. This recommendation will serve as a tool to treat this high burden of patients with RA scientifically and more effectively.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 153","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"6 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141378608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Female Hypoactive Sexual Desire Disorder: What physicians need to know ?","authors":"Mohammad Shamsul Ahsan","doi":"10.3329/bjm.v35i20.73367","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73367","url":null,"abstract":"Hypoactive sexual desire disorder (HSDD) is a persistent or recurrent deficiency or absence of sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty not related to a medical or psychiatric condition or the use of a substance or medication. Factors responsible are bio-psycho-social and contextual. Earlier female sexuality was  not discussed and more so in Bangladesh. Over the past decade there are number of studies in western world and very few in Bangladesh. Survey  on female HSDD showed that up to 80% are reluctant to talk about their sexuality to health care providers and  at least 50% have discomfort or embarrassment and  unwilling  to seek treatment. Often vague somatic symptoms are the presenting features. Appropriate knowledge, skills and attitude is crucial to address the issue and comprehensive assessment.  Bio-psycho-social factors are related to female HSDD like altered hormones, neurotransmitters and their interactions, medical conditions like diabetis, urinary incontinence and psychiatric illness. The psychological  factors, such as boredom, situational stress, self-consciousness about body image, and distraction; and social and contextual factors that include cultural norms, familial teachings, and relationship considerations. Treatment approach also needs to consider the bio-psycho-social aspects.\u0000Bangladesh J Medicine, 2024; Vol. 35, No. 2, Supplementation: 145","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"33 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141376392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Effectiveness of the three Novel Lipid Indices in predicting Metabolic Syndrome in young Bangladeshi Adults : A Cross-sectional study","authors":"Mariya Tabassum","doi":"10.3329/bjm.v35i20.73271","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73271","url":null,"abstract":"Background : Metabolic Syndrome is directly linked with the development of Type 2 DM, cardiovascular diseases and stroke. Due to ethnic predisposition of the people of this region, Bangladesh is currently facing “metabolic syndrome” as a major public health challenge, with huge economic and social burdens. A number of studies in the recent years have reported three newer lipid indices, namely, LAP (Lipid Accumulation Product), TyG (Triglyceride-Glucose) index and VAI (Visceral Adiposity Index), as better performers than conventional markers, in predicting metabolic syndrome. These are gender-specific mathematical formulae, comprising anthropometric and biochemical parameters. The aim of the study is to establish the diagnostic cut-off values of the novel lipid indices and compare their effectiveness with one another in detecting metabolic syndrome in young Bangladeshi adults. Methods: 200 adults from 19 to 45 years of age and meeting all the inclusion criteria, were recruited for this cross-sectional study. Anthropometric measurements & blood pressure of the study subjects were recorded in preformed data sheets. Then their fasting blood glucose, serum Triglyceride & serum HDL-C concentrations were estimated. Study subjects were then classified into two groups, having metabolic syndrome or not, depending on the “National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III)” criteria. Results: Sensitivity, Specificity, Positive Predictive value and Negative Predictive value of LAP as diagnostic marker were 90.91%, 75.00%, 74.07% and 91.30% respectively; Sensitivity, Specificity, Positive Predictive value and Negative Predictive value of TyG index as diagnostic marker were 95.45%, 79.46%, 78.50% and 95.70% respectively; Sensitivity, Specificity, Positive Predictive value and Negative Predictive value of VVI as diagnostic marker were 92.05%, 75.00%, 74.31% and 92.31% respectively. Prevalence of metabolic syndrome among the study subjects was 42.00%, according to the NCEP ATP III criteria. 54.00% of the total study subjects had metabolic syndrome based on the optimal cut-off value of LAP; 53.50% of the total study subjects had metabolic syndrome based on the optimal cut-off value of TyG index; 54.50% of the study subjects had metabolic syndrome based on the optimal cut-off value of VAI. Conclusion: LAP, TyG index and VAI, all showed to be effective predictors of metabolic syndrome, with VAI showing slightly stronger predictive power than LAP and TyG index in case of young Bangladeshi adults.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 159-160","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141377768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electroencephalography in Detection of Minimal Hepatic Encephalopathy in Cirrhotic Patient","authors":"Sushatna Kumar Mahapatra, H. Aftab","doi":"10.3329/bjm.v35i20.73451","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73451","url":null,"abstract":"Background: Minimal hepatic encephalopathy (MHE) is a common complication of cirrhosis of liver which significantly impairs the patient’s quality of life and often progress to overt hepatic encephalopathy. Psychometric Hepatic Encephalopathy Score (PHES) test is considered as the gold standard for diagnosing minimal hepatic encephalopathy (MHE), but its value is limited in cases where patients cannot read or write. In such cases, electroencephalography (EEG) could be alternative diagnostic tool. The aim of this study was to evaluate the diagnostic value of electro-encephalography (EEG) in detection of minimal hepatic encephalopathy, so that this test could be employed for individuals who are unable to read or write. Methods: This cross-sectional study was conducted in the department of Gastroenterology, Dhaka Medical College Hosptial, from April 2022 to March 2023. Ninety patients with cirrhosis without having overt hepatic encephalopathy were assessed by both PHES and EEG tests. Then diagnostic value of electroencephalography (EEG) was assessed. Results: In this study, the diagnostic performance of Electroencephalography (EEG) was evaluated, revealing a sensitivity of 70.7%, specificity of 89.8% and accuracy of 81.11%. Positive predictive value & negative predictive value were 85.29% & 78.57% respectively. Conclusion: Electroencephalography (EEG) has demonstrated satisfactory results in the detection of minimal hepatic encephalopathy. Electro-encephalography (EEG) can be employed as a diagnostic tool to detect minimal hepatic encephalopathy in cirrhotic patients when the Psychometric Hepatic Encephalopathy Score (PHES) test could not be applied, such as in cases where patients are unable to read or write.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 170","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"97 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141378078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hand-Held Ultrasound (HHU) as a Diagnostic and therapeutic tool in bedside clinical medicine","authors":"Abdur Rahim, Md Rafiqul Islam, Abtahir Rahim Taha, Tahmid Bhuiyan","doi":"10.3329/bjm.v35i20.73385","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73385","url":null,"abstract":"Ultrasound is a sound wave that can be generated with a transducer via piezoelectric crystals and received to produce 2D images on a screen.  The evolution of ultrasound device from traditional cart based to hand held devices has massively increased its use in the bedside clinical setting which is called point of care ultrasound (PoCUS).  Its application is extensive ranging from lung ultrasound which can rapidly determine an effusion, edema or consolidation to determining the hemodynamic and cardiac parameters in critically ill patients.  This can be done by checking the Inferior vena cava (IVC) diameter and left ventricular ejection fraction.  Besides this, with high frequency probes, vascular integrity and difficult vascular access can be easily established.  Rapid assessment of trauma patients and surgical abdomen can also be established with ease.  In short, now is the time for physicians to take hand held USG devices as routine tool for clinical examination as it will increase diagnostic accuracy and improve care in medicine.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 150-151","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"6 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141380523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in Diagnosing Gallbladder Tuberculosis Mimicking Acute Calculus Cholecystitis: A Case Report of an Uncommon Presentation","authors":"Sirajam Munira, Mehedi Hasan, Rukshana Jolil, Jahangir Md Sarwar","doi":"10.3329/bjm.v35i20.73448","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73448","url":null,"abstract":"Gall bladder tuberculosis (TB) represents a highly uncommon form of extrapulmonary TB, even within endemic regions, presenting a considerable diagnostic challenge. Limited pre-operative diagnostic tools lead to cholecystectomy and tissue analysis to initiate definitive treatment, thereby prolonging patient suffering and delaying diagnosis. A 50-year-old menopausal lady presented with history of prolonged fever, significant weight loss, and subsequent upper abdominal pain. Serological and blood biochemistry tests revealed normal findings, except for moderate anemia. Abdominal ultrasound detected cystitis, while MRCP revealed a distal common bile duct stricture concomitant with gallstones. However, ERCP failed to confirm the biliary stricture, instead revealing papillary stenosis. The initial diagnosis was cholelithiasis, leading to laparoscopic cholecystectomy. The histopathological examination of the specimen indicated the presence of granulomas consisting of epithelioid cells and multinucleated giant cells. Additionally, areas of necrosis and chronic inflammatory cell infiltration were observed within the gallbladder wall. Histopathology of Lymph node biopsy showed granulomas, multinucleated giant cells, and areas of necrosis. Category-1 Anti-Tubercular Therapy was initiated postoperatively, resulting in favorable clinical and operative outcomes. Although gall bladder TB is a rare entity, clinicians should raise a high index of suspicion for TB in patients presenting with prolonged fever, weight loss, and features suggestive of calculus cholecystitis in endemic areas, aiming to mitigate unnecessary investigations and treatments, particularly in resource-limited settings such as Bangladesh.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 168-169.","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"2 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141381686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}