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Recurrent bilateral Mycobacterium bovis necrotizing epididymitis: a case report.

ABSTRACT: BACKGROUND:Mycobacterium bovis causing tuberculosis in animals is responsible for zoonotic tuberculosis in patients. Veterinary control measures and milk pasteurization has led to a significant decrease in human cases of M. bovis infections in developed countries. CASE PRESENTATION:We diagnosed recurrent M. bovis epididymitis in a 63-year old Caucasian man without any signs of pulmonary or disseminated disease. Relevant epidemiological expositions included camel milk drinking during prolonged travels in Niger, prior to initial clinical manifestations. The diagnosis was firmly established by mass spectrometry and DNA sequencing on epididymis surgical biopsy specimens. We detail therapeutic management which included surgical epididymectomy and hydrocele repair. CONCLUSION:As for other M. tuberculosis complex species, the genitourinary tract represents a frequent site of secondary dissemination and latency for M. bovis. Isolated epididymis infection is a newly documented manifestation of M. bovis disease.

SUBMITTER: Grandjean-Lapierre S

PROVIDER: S-EPMC5960082 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Recurrent bilateral Mycobacterium bovis necrotizing epididymitis: a case report.

Grandjean-Lapierre Simon S Thiberville Simon-Djamel SD Fellag Mustapha M Eghazarian Christophe C Bouzid Feriel F Gavril Christina C Drancourt Michel M

BMC research notes 20180518 1

<h4>Background</h4>Mycobacterium bovis causing tuberculosis in animals is responsible for zoonotic tuberculosis in patients. Veterinary control measures and milk pasteurization has led to a significant decrease in human cases of M. bovis infections in developed countries.<h4>Case presentation</h4>We diagnosed recurrent M. bovis epididymitis in a 63-year old Caucasian man without any signs of pulmonary or disseminated disease. Relevant epidemiological expositions included camel milk drinking duri ...[more]

PMID: 29776430

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Project description:BackgroundOcular neuromyotonia (ONM) is characterized by episodic diplopia, which is usually triggered by prolonged eccentric gaze of the affected extraocular muscles. The spell is characterized by involuntary, occasionally painful, sustained contraction of one or more extraocular muscles innervated by the oculomotor, trochlear, or abducens nerve. ONM usually occurs as a late consequence of radiotherapy around the parasellar area, although idiopathic cases have been reported. Most cases are unilateral; however, bilateral ONM has occasionally been described.Case presentationA 60-year-old woman presented with a 4-month history of episodic, painful, horizontal binocular diplopia. She underwent external beam radiotherapy to the skull base for treatment of nasopharyngeal carcinoma. The tumor was well controlled. General neurological examination findings were unremarkable. Neuro-ophthalmic examination revealed normal visual acuity, visual fields, pupils, and fundi. Ocular alignment showed orthotropia with normal ocular motility. Myasthenic eyelid signs were absent. However, she developed episodes of involuntary sustained contraction of the medial rectus muscle following prolonged eccentric gaze toward the affected medial rectus muscle, which resulted in esotropia upon returning to the primary position. The esotropic episodes spontaneously resolved after approximately 2 min. These spells affected both medial rectus muscles. Both pupils remained normal throughout the examination. Magnetic resonance imaging revealed neither brain parenchyma/brain stem lesions nor tumor recurrence. Her symptoms were successfully treated with carbamazepine.ConclusionsEpisodic esotropia in the adducting eye following prolonged horizontal eccentric gaze is a significant characteristic of ONM affecting the bilateral medial rectus muscles (i.e., bilateral oculomotor ONM). In spite of its extreme rarity, ONM should be considered as a differential diagnosis of episodic diplopia, especially in patients with a history of radiotherapy around the parasellar area. Careful examination with prolonged eccentric gaze should be performed to achieve a correct diagnosis and avoid an extensive unnecessary workup.

Dataset Information

Recurrent bilateral Mycobacterium bovis necrotizing epididymitis: a case report.

Publications

Recurrent bilateral Mycobacterium bovis necrotizing epididymitis: a case report.

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