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 Table of Contents  
LETTER TO EDITOR
Year : 2018  |  Volume : 5  |  Issue : 2  |  Page : 164

Calvarial tuberculosis presenting as multiple osteolytic soft-tissue lesions


Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq

Date of Web Publication9-Apr-2018

Correspondence Address:
Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_120_17

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How to cite this article:
Al-Mendalawi MD. Calvarial tuberculosis presenting as multiple osteolytic soft-tissue lesions. CHRISMED J Health Res 2018;5:164

How to cite this URL:
Al-Mendalawi MD. Calvarial tuberculosis presenting as multiple osteolytic soft-tissue lesions. CHRISMED J Health Res [serial online] 2018 [cited 2019 Mar 21];5:164. Available from: http://www.cjhr.org/text.asp?2018/5/2/164/229584



Sir,

I read with interest the case report by Ravikanth et al. published in the October 2017 issue of CHRISMED J Health Res.[1] The authors nicely described the clinical picture, diagnostic work-up, and the treatment plan instituted to the patient. I presume that the underlying human immunodeficiency virus (HIV) infection ought to be considered in the case in question. My presumption is based on the following point. With the improvement in the socioeconomic standards and the development of effective antituberculosis (TB) therapy, there has been a decline in TB in many parts of the world. However, in the era of HIV epidemic, atypical, and extrapulmonary TB presentations have been noticed to constitute the major proportion of new TB cases.[2] To my knowledge, HIV infection is still a substantial health hazard in India. Though no recent data are yet present on the exact national HIV seroprevalence in India, the available published data pointed out to HIV prevalence of 0.26% compared with a global average of 0.2%.[3] Moreover, the prevalence of HIV/TB coinfection among HIV Indian patients has been reported to be substantial (12.3%), and 56% of TB lesions in patients with HIV/TB coinfection were found to be extrapulmonary.[4] It has been recommended that all TB patients in India should be assessed for HIV-risk factors and counseled to undergo HIV testing. Conversely, all HIV-positive cases should be screened for TB.[4] Accordingly, contemplating the diagnostic algorithm of CD4 count and viral overload measurements was envisaged in the studied patient. If that diagnostic algorithm was done and it revealed underlying HIV infection, the case in question could be confidently considered a second novel case report of HIV-associated skull TB in India as the first case was reported one decade ago.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ravikanth R, Mathew S, Selvam RP. Calvarial tuberculosis presenting as multiple osteolytic soft tissue lesions. CHRISMED J Health Res 2017;4:278-9.  Back to cited text no. 1
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2.
Saleeb PG, Buchwald UK. Update on the epidemiology, diagnosis and therapy of tuberculosis in HIV-infected patients. Pneumologie 2014;68:666-75.  Back to cited text no. 2
    
3.
Paranjape RS, Challacombe SJ. HIV/AIDS in India: An overview of the Indian epidemic. Oral Dis 2016;22 Suppl 1:10-4.  Back to cited text no. 3
    
4.
Manjareeka M, Nanda S. Prevalence of HIV infection among tuberculosis patients in Eastern India. J Infect Public Health 2013;6:358-62.  Back to cited text no. 4
    
5.
Tripathi AK, Gupta N, Khanna M, Ahmad R, Tripathi P. Tuberculosis presenting as osteolytic soft tissue swellings of skull in HIV positive patient: A case report. Indian J Tuberc 2007;54:193-5.  Back to cited text no. 5
    




 

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