Lung CT scan demonstrated multiple bilateral nodules. Bronchoalveolar lavage (BAL) specimen revealed acid fast bacilli and after two months, culture was positive for Mycobacterium TUBERCULOSIS. Skin biopsy was performed from the affected area which revealed leukocytoclastic vasculitis. Considering the associated systemic vasculitis, a CTguided biopsy of PULMONARY lesions was done which was not diagnostic. Therefore, open lung biopsy was performed and histopathological study demonstrated chronic granulomatous inflammation associated with necrosis.

Background: Mycobacterium TUBERCULOSIS usually infects the lungs; however, organs other than the lungs may also be involved. This study is an analysis of the situation of extra-PULMONARY TUBERCULOSIS in the Markazi province, Iran.Materials and Methods: In this cross-sectional study, the information in the registration software of TUBERCULOSIS in health centers was collected and SPSS software 16 was applied to data analysis.Results: In the survey, a total of 1787 TB patients were identified, of whom 24.2% were diagnosed with extra-PULMONARY TUBERCULOSIS and 1.9 % of the patients with extra-PULMONARY TB were associated with HIV infection. Female to male sex ratio was equal to 1.3. Overall, 82.5% of the patients were Iranian and mean age of patients were 43.3 years. TUBERCULOSIS of the lymph nodes and skeletal and pleural TUBERCULOSIS had the highest prevalence. Moreover, extra-PULMONARY TUBERCULOSIS in females, aged 15-55 years, was more and the diagnosis delay was more common in extra-PULMONARY TUBERCULOSIS while relapse occurred more frequently in PULMONARY TUBERCULOSIS.Conclusion: Noticing the greater diagnosis delay in extra-PULMONARY TUBERCULOSIS, it is necessary to train physicians and other healthcare workers in extra-PULMONARY TB diagnosis and more planning needed for instructing it.

Background: Despite the increased rate of TUBERCULOSIS (TB) in the elderly, few publications have presented the clinical characteristics of TB in this specific age group in our country. This study aimed to compare the clinical features, predisposing factors and imaging findings of PULMONARY TB in the elderly and in young adults, and to determine if any difference exists between the two groups.Materials and Methods: We retrospectively reviewed the records of all patients with the diagnosis of PULMONARY TB at Ghaem Hospital and outpatient clinics during a 6-year period. Ninety-five patients were studied and divided into two groups, 33 patients were in the young group (mean age, 29.3 yrs.) and 40 patients in the elderly group (mean age, 69.6 yrs.) Patients aged 46-64 were excluded from the study.Results: Predisposing factors were more prevalent in the elderly who had a significantly higher frequency of chronic obstructive PULMONARY disease, ischemic heart disease, congestive heart failure, malignancy and diabetes mellitus.Pregnancy and postpartum status were the predisposing conditions in young females. The classic symptoms and signs of TB were noted in a higher proportion of the younger group. Fever (78% vs. 57.5%), and weight loss(94% vs. 80%) were significantly higher (p<0.05),while night sweats(24% vs. 22.5%),cough (100% vs. 92.5%) and hemoptysis (30% vs. 15%), were seen more in the younger group but with no significant differences .Lower lung infiltrates were higher in the elderly; whereas, cavitation was seen significantly more in the young age group(63% vs. 25%, p<0.05).Conclusion: To prevent delay in diagnosis and treatment, TB should be considered among the differential diagnosis of any type of PULMONARY infiltrates seen in the elderly, even when the clinical presentation is atypical.

Background: TUBERCULOSIS of the larynx is a rare form of TUBERCULOSIS. Patients usually present with hoarseness or dysphagia and other nonspecific constitutional symptoms like fever or localized pain. In this study, we present a case of primary vocal cord lesion with TUBERCULOSIS.Case presentation: A 72 year old man presented with hoarseness of voice, low grade fever, and night sweating within three months duration. Laryncoscopic study showed unilateral thickening of vocal cord and biopsy of the lesion showed granuloma with caseous necrosis. Chest x-ray was normal. The patient was treated with standard regimen of TUBERCULOSIS and was cured after 6 months of therapy.Conclusion: Laryngeal TUBERCULOSIS should be considered in the differential diagnosis of patients with hoarseness without PULMONARY involvement in endemic regions of TUBERCULOSIS.