Tuberculosis (TB) is one of the leading infectious causes of morbidity and mortality worldwide. Either in its pulmonary (PTB) or extrapulmonary forms (EPTB), TB has a wide variety of manifestations, including hematological ones like thrombocytosis (especially in PTB) and thrombocytopenia (mainly with disseminated or miliary TB). Hematological manifestations are infrequently presenting features of TB, and within them, immune thrombocytopenic purpura (ITP)-associated TB is one of the rarest presenting features. We report a case of a 22-year-old woman with a diagnosis of ganglionic tuberculosis (GTB) presenting with ITP. The therapeutic approach was challenging and included the use, originally, of intravenous immunoglobulin 30 mg/day for five days and, posteriorly, of high-dose corticosteroids (dexamethasone 40 mg/day) and anti-tubercular therapy with satisfactory outcomes.

In this study, we aimed to assess the performance of Xpert in fresh tissue and formaldehyde-fixed and paraffin embedded (FFPE) specimens from suspected lymphatic tuberculosis for the diagnosis of Mycobacterium tuberculosis (MTB). A total of 52 suspected lymphatic tuberculosis (TB) samples and 10 non-tuberculous lymph nodes samples were collected from outpatients. Using the comprehensive diagnostic criteria as the gold standard, the specificity in fresh and FFPE samples was 100% and the sensitivity was 82.7% and 67.3%, respectively. The majority of fresh tissue specimens had medium and low MTB content, while the low and very low MTB content were noted in 42.9% and 54.3% of FFPE tissue specimens, respectively. There were statistical differences in the MTB content between the two specimen groups detected by Xpert. Three rifampicin-resistant cases in FFPE samples were noted as rifampicin-susceptible in fresh tissue samples. Notably, all three cases with contradictory results of rpoB gene mutation test in fresh and FFPE samples had very low MTB content in FFPE samples. Fresh tissue specimens are more likely to yield Xpert results with high greater MTB content than FFPE specimens from lymphatic TB. The false detection of rpoB mutants is associated with the low bacterial content in the specimens.

To determine the incidence of extra-pulmonary tuberculosis (EPTB) and examine the risk factors and the clinical features of the disease over a ten-year period.
Retrospective study of records of patients who were followed and registered in the TB registry programme in the health district of Gorgan, Iran from January 1, 2008, through December 31, 2017.
Among 2280 TB records, 609 (26.71%) were EPTB. They were mostly female patients (53.7%) and residents in rural areas (56.5%) with a mean age of 40.55 years [±16]. The average age of female patients (37.55 years [±16.99]) was lower than of male patients (44.07 years [±20.59]). The median of the incidence rate was 7.5 per 100 000 inhabitants for EPTB; biopsy and pathology were the best methods for the detection of EPTB. The most frequent forms of EPTB were lymphatic TB (193/609 = 31.7%) and pleural TB (158/609 = 25.9%). In most cases (245/609 = 40.2%), one to three months elapsed between occurrence of symptoms and final confirmation of EPTB. The outcome of EPTB was weaker than of pulmonary TB (PTB).
Our most important finding was the increasing incidence of EPTB, which shows the importance of attention to this disease. Lymph node and pleural tissue were the most commonly infected tissues. Skeletal TB presents a challenge in the diagnosis and treatment of EPTB.
Déterminer l\'incidence de la tuberculose extra-pulmonaire (EPTB) et examiner les facteurs de risque et les caractéristiques cliniques de la maladie sur une période de dix ans. MÉTHODES: Etude rétrospective des dossiers des patients qui ont été suivis et enregistrés dans le programme d\'enregistrement de la TB dans le district de santé de Gorgan, en Iran, du 1er janvier 2008 au 31 décembre 2017. RÉSULTATS: Parmi 2.280 enregistrements de TB, 609 (26,71%) étaient des EPTB. Il s\'agissait principalement de femmes (53,7%) et de résidents des zones rurales (56,5%) avec un âge moyen de 40,55 ans [± 16]. L\'âge moyen des patients de sexe féminin (37,55 ans [± 16,99]) était inférieur à celui des hommes (44,07 ans [± 20,59]). La médiane du taux d\'incidence était de 7,5 pour 100.000 habitants pour l\'EPTB; la biopsie et la pathologie étaient les meilleures méthodes pour la détection de l\'EPTB. Les formes les plus fréquentes d\'EPTB étaient la TB lymphatique (193/609 = 31,7%) et la TB pleurale (158/609 = 25,9%). Dans la plupart des cas (245/609 = 40,2%), un à trois mois s’étaient écoulés entre l\'apparition des symptômes et la confirmation finale de l\'EPTB. Le résultat de l\'EPTB était plus faible que celui de la TB pulmonaire (PTB).
Notre découverte la plus importante a été l\'incidence croissante d\'EPTB, ce qui montre l\'importance de l\'attention portée à cette maladie. Les ganglions lymphatiques et les tissus pleuraux étaient les tissus les plus fréquemment infectés. La TB osseuse présente un défi dans le diagnostic et le traitement de l\'EPTB.

Infection can cause cerebral vasculitis not only by direct invasion of the vessel wall, but by immune complex deposition, or through secondary cryoglobulineamia. There are also two types of cerebral vasculitis associated with tuberculosis (TB). In TB treatment, cerebral vasculitis caused by immunologic injury received little attention than vasculitis due to direct invasion of TB infection. We report a case in a young woman who presented with fever, generalized lymphadenopathy, stroke-like events, movement disorder and coma, which was found to be active, lymph node TB with immunologic cerebral vacuities without tuberculosis meningitis.