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Dr Mohan Z Mani

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On Sep 2018




Prof. Somashekhar Nimbalkar

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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case report
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : OD07 - OD10 Full Version

An Unusual Presentation of Tuberculosis at Atypical Anatomical Location: Rectus Abdominis Muscle


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/53255.16488
Abhishek Kumar, Ajay Shankar Prasad, Neel Kanth Issar, Harsh Pandey, Prateek

1. Medical Officer, Department of Station Medicare Centre, 11 Air Force Hospital, Ghaziabad, Uttar Pradesh, India. 2. Commanding Officer, Department of Medicine, 11 Air Force Hospital, Ghaziabad, Uttar Pradesh, India. 3. Medical Specialist, Department of Medicine, 11 Air Force Hospital, Ghaziabad, Uttar Pradesh, India. 4. Surgical Specialist, Department of Surgery, 11 Air Force Hospital, Ghaziabad, Uttar Pradesh, India. 5. Radiologist, Department of Radio diagnosis, 11 Air Force Hospital, Ghaziabad, Uttar Pradesh, India.

Correspondence Address :
Abhishek Kumar,
Medical Officer, Officers Mess, Air Force Station, Hindan, Ghaziabad, Uttar Pradesh-201004, India.
E-mail: drabhik08@gmail.com

Abstract

Unusual presentation of Tuberculosis (TB) in anatomical locations like skeletal muscle which are atypical and not favorable for survival and multiplication of Mycobacterium tuberculosis. Commonly, muscle involvement is secondary. A direct inoculation (abdominal lymph node) or extension from underlying tubercular synovitis and osteomyelitis may involve an abdominal muscle. The case report is about a 43-year-old female who presented with an abdominal lump for past one month. There was no history of cough, weight loss, pain abdomen, recurrent vomiting, breathlessness and no history of TB or close contact with TB patient. Ultrasound (USG) and Contrast Enhanced Computed Tomography (CECT) of the abdomen revealed loculated collection in right rectusabdominis muscle, and USG-guided aspiration for cytology, culture and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) confirmed tubercular abscess. The patient was managed as per National Tuberculosis Elimination Programme and responded well with antitubercular drug therapy for six months. This case throws light on to the possibility of tubercular infection in atypical anatomical locations as primary foci, especially in those areas where tuberculosis is endemic.

Keywords

Atypical abdominal tuberculosis, National tuberculosis elimination programme, Skeletal muscle tuberculosis

Case Report

A 43-year-old female patient presented with complaint of gradually increasing swelling over anterior abdominal wall for past one month. She also complained of pain at the site of swelling, while coughing. There was no history of trauma or similar swellings elsewhere in the body. No previous history of tuberculosis/ malignancy, hypertension, diabetes mellitus, chronic respiratory disease or irregularities in menstrual history. Patient was multiparous, with two male children (both full term vaginal deliveries) and last child birth was 15 years back. There was no family history of tuberculosis, hypertension, diabetes mellitus.

Physical examination of the patient revealed a single non tender, well defined swelling of size 3x3 cm on the anterior abdominal wall to the right of midline in the hypochondrial region. The swelling was cystic in consistency and did not disappear when the anterior abdominal muscles were made taut. There was no local rise of temperature. There was neither generalised lymphadenopathy nor any lymphnodes on the typical sites, i.e, cervical, axillary, supraclavicular, inguinal. No abnormalities were detected on routine systemic examination.

Chest X-ray was normal. Complete blood counts and biochemical profile was within normal limits (haemoglobin was 12.3 mg/dL, Total Leucocyte Count (TLC) was 6800/cmm, neutrophils were 65, lymphocytes were 28, monocytes were five, eosinophils were two, platelet count was 1,90,000/μL. Serum total bilirubin was 0.5 mg/dL, serum direct bilirubin was 0.2 mg/dL, Aspartate Sminotransferase (AST) and Alanine aminotransferase (ALT) was 17 U/L and 21 U/L, respectively, Serum creatinine was 0.9 mg/dL. Fasting and post prandial blood sugar were 89 mg/dL and 130 mg/dL, respectively. Erythrocyte Sedimentation Rate (ESR) was raised (65 mm/ hr). C-Reactive Protein (CRP) was elevated (7.47 mg/L). Viral markers i.e, Human Immunodeficiency Virus (HIV), Hepatitis B surface antigen (HBsAg), Hepatitis C antibody test, were negative. Ultrasound (USG) of the abdomen revealed loculated collection in right rectus abdominus muscle measuring 30x28x33 mm (10 cc), with anechoic-echo genic contents, floaters and few septae. Peripheral vascularity seen. No other significant abnormality was seen on USG examination (Table/Fig 1).

The patient was further evaluated with Contrast Enhanced Computed Tomography (CECT) scan of abdomen which revealed loculated thick collection (9.7 mL) in anterior abdominal wall involving the rectus sheath in right side epigastric region bulging intraperitoneally (Table/Fig 2). Differential diagnosis of rectus muscle abscess, infected haematoma of rectus muscle and exophytic hepatic abscess with extension into rectus muscles were considered based on clinical and radiological findings.

Ultrasound-guided aspiration of the swelling was done and sample was sent for microscopy, culture and Cartridge Based Nucleic Acid Amplification Test (CBNAAT). Aspiration cytology revealed presence of chronic inflammatory cells with few epithelium cells. However, there was no evidence of acid fast bacilli or caseous necrosis on microscopic examination of the aspirate. The CBNAAT detected Mycobacterium tuberculosis, which was sensitive to rifampicin.

In view of the above, the patient was diagnosed to have tubercular cold abscess ofanterior abdominal wall.Incision and drainage of the abscess was done (Table/Fig 3). Patient was started on antitubercular drugs as per National Tuberculosis Elimination programme. The Antitubercular Treatment (ATT) regime consisted of two months of intensive phase (isoniazid 300 mg once daily, rifampicin 600 mg once daily, ethambutol 1200 mg once daily, pyrazinamide 1500 mg once daily, pyridoxine 40 mg once daily) and four months of continuous phase (isoniazid 300 mg once daily, rifampicin 600 mg once daily and pyridoxine 40 mg once daily). After two months of ATT regime, the swelling reduced in size significantly and was almost non palpable (Table/Fig 4). There was no evidence of any fluid collection or discharging sinus, as evaluated clinically and radiologically.

Discussion

India has the highest burden of TB patients in the world with incidence being 159/lakh population in 2019 (1). It has varied manifestations, most common being pulmonary tuberculosis. The commonest Extra Pulmonary Tuberculosis (EPTB) sites are lymph nodes, pleura, gastrointestinal, central nervous system and urogenital tuberculosis in western countries (2),(3). In Indian context, lymph node tuberculosis is the commonest EPTB site in children (0-14 years). However, a shifting pattern in EPTB site with increasing age has been documented and pleural tuberculosis is the commonest EPTB site in patients aged more than 45 years. This raises the possibility that the reactivation in pleura may be higher as the age increases (4). Other common EPTB sites in decreasing order of frequency after lymph node and pleura are abdomen, bones and joints, skin and muscles (5),(6),(7),(8). Pollet S et al., reported the incidence of EPTB in decreasing order as lymph node, pleura, gastrointestinal, central nervous system, bone and genitourinary in tertiary care units of Australia (9). Similar incidence was also reported by Sama JN et al., in United States of America (10). Hence, the site of involvement of EPTB has remain the same irrespective of incidence in low or high prevalence areas.

An unusual presentation of Tuberculosis (TB) as anterior abdominal mass in an immunocompetent patient has been reported here.Musculoskeletal tuberculosis occurs in 1% to 5% of all TB cases among which anterior abdominal wall TB has been rarely reported (3),(4),(11),(12),(13),(14).The striated muscles are rarely affected by TB because chances of survival of Mycobacterium tuberculosis is significantly less as compared to other sites (15). Inoculation from the caseous lymph nodes in the vicinity and dissemination of a primary focus via hematogenous route are the common modes of muscle involvement (16).

Srivastava P et al., reported a case of a 31-year-old immunocompetent male, who presented with an abdominal wall swelling for one and half months which was gradually increasing in size.The diagnosis was confirmed using USG-based Fine Needle Aspiration Cytology (FNAC), which showed the presence of acid-fast bacilli (17).

Another publication reported a lower abdomen swelling (left iliac fossa) tuberculosis in a 20-year-old immunocompetent female (18). A similar case was reported in a 40-year-old male who reported with an abdominal swelling for 4 months. Diagnosis in this case was confirmed by CBNAAT as histopathological examination failed to reveal presence of acid fast bacilli (19).

In all the three cases stated in (Table/Fig 5), an immunocompetent patient presented with common complaints of gradually increasing, painless swelling over anterior abdominal wall with either minimum or no systemic features of tuberculosis like fever, weight loss, easy fatiguability. There was history of tuberculosis in the past. There was no recent history of trauma, contact with tuberculosis patient. Differential diagnosis of rectus muscle abscess, infected hematoma of rectus muscle was considered, similar to the index patient.

In the present case, differential diagnosis of hydatid cyst was ruled out by a negative anterior indirect hemagglutinin test (17). Infected hematoma was ruled out as aspirate was predominantly purulent and microscopy did not show presence of significant Red Blood Cells (RBC). Diagnosis of tuberculosis was confirmed on basis of microscopy or by CBNAAT. All the patients were managed with antitubercular therapy comprising of two months of HRZE and 4 months of HR. All the patients responded well to ATT. The abscess resolved over 6 months with no recurrence in form of abscess or sinus.

In the present case, the patient had an abscess in right rectus abdominis muscle. There was no significant bone or joint involvement. Investigations did not reveal any other active focus of infection in the body. The USG abdomen revealed thick walled peripherally enhancing lesions in abdomen. The CECT abdomen confirmed the findings of USG abdomensuggestive of abscess.The diagnosis of tuberculosis was established by USG guided aspiration of abscess followed by CBNAAT testing of the aspirate. The treatment was by antitubercular drug therapy. In our case patient showed treatment response after four weeks of intensive phase of therapy. Patient was followed-up till completion of therapy.

The incidence in striated muscle is limited because of relatively high lactic acid content and profuse blood supply. Dissemination to muscle via lymphatic route is rare because of scarcity of reticuloendothelial cells and lymphatic tissue. The highly differentiated state of muscle tissue hinders the proliferation of Mycobacterium tuberculosis (20),(21).

Involvement of abdominal muscles can be via two routes- hematogenous or via neighboring lymph nodes or ribs (22). Muscular tuberculosis clinically presents commonly as swelling and pain, which is usually insidious in onset and gradually progressive in size. Infection is usually restricted to one muscle (23). There may be either a frank tubercular abscess or nodular sclerosis with calcification. CT of the abdomen usually shows a well-defined abscess in the abdominal wall (24),(25).

Culture and histopathological examination are gold standard for diagnosis of tuberculosis. The CBNAAT is an effective tool for rapid diagnosis. It also provides information on resistance of bacteria to rifampicin. Hence, National Tuberculosis Elimination Programme recommends use of CBNAAT for diagnosis. The sensitivity of Ziehl–Neelsen (ZN) stain for Acid-Fast Bacillus (AFB) and chest radiograph is very less. Hence, a negative ZN stain for AFB and normal chest radiograph does not rule out the diagnosis of tuberculosis, especially in patients with no contact history of tuberculosis and no active tubercular foci. Therefore, in countries like India where the prevalence of TB is very high, a high index of suspicion is required for early diagnosis and treatment.

Tuberculous myositis is quite uncommon, with an incidence of 0.015-2% of total extra pulmonary tuberculosis (26).The incidence of primary muscular TB is so rare, it is often misdiagnosed as muscular tumor without any bony involvement (21). The diagnosis is essentially based on histology. However, in the present case CBNAAT confirmed the diagnosis and CECT abdomen sufficed the extent of lesion.

The skeletal muscles are involved usually by a direct extension from a neighboring joint or cold abscess but rarely by haematogenous spread (27). A tubercular abscess arising in the costochondral junction may track downward, either lateral or medial to the linea semilunaris. If it extends lateral to the rectus, they spread downward between internal oblique and the transversus muscles, but if it extends medial to the linea semilunaris it may spread into the sheath of rectus and may extend downward behind the muscle (16).

The multimodality approach of clinical evaluation, radiology and cytology imagery, molecular tests provide comprehensive evidence for diagnosis of skeletal muscle tuberculosis. The threshold for considering skeletal muscle tuberculosis as differential diagnosis should be kept low for timely treatment and to prevent complications especially in endemic areas (28),(29).

Conclusion

Despite the efforts of the TB elimination programs in endemic countries like India, incidence of extrapulmonary tuberculosis, especially in the atypical sites, is being constantly reported. Hence, clinicians should be vigilant in diagnosing atypical presentations of TB, thus reducing the morbidity and mortality.

References

1.
National Tuberculosis Elimination Programme. India TB report [Internet]. 2021. [Accessed on 2021 Jan 28]. Available from https://tbcindia.gov.in/showfile.php?lid=3587.
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Kulchavenya E. Extrapulmonary tuberculosis: Are statistical reports accurate? Therapeutic Advances in Infectious Disease. 2014;2:61-70. [crossref] [PubMed]
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Sunnetcioglu A, Sunnetcioglu M, Binici I, Baran AI, Karahocagil MK, et al. Comparative analysis of pulmonary and extrapulmonary tuberculosis of 411 cases. Ann Clin Microbiol Antimicrob. 2015;14:34. [crossref] [PubMed]
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Prakasha SR, Suresh G, D’sa IP, Shetty SS, Kumar SG. Mapping the pattern and trends of extrapulmonary tuberculosis. J Global Infect Dis. 2013;5:54-59. [crossref] [PubMed]
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Yang H, Field SK, Fisher DA, Cowie RL. Tuberculosis in Calgary, Canada, 1995-2002: site of disease and drug susceptibility. Int J Tuberc Lung Dis. 2005;9(3):288-93.
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Arora VK, Gupta R. Trends of extra-pulmonary tuberculosis under Revised National Tuberculosis Control Programme: A study from South Delhi. Indian J Tuberc. 2006;53:77-83.
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Rai DK, Bisht RS, Sikarwar V, Upadhyay SK. Clinicoepidemiological trend of tuberculosis in Garhwalregion. IOSR Journal of Pharmacy. 2012;2(5):39-43. [crossref]
8.
Zhang X, Andersen AB, Lillebaek T, Kamper-Jørgensen Z, Thomsen VØ, Ladefoged K, et al. Effect of sex, age, and race on the clinical presentation of tuberculosis: a 15-year population-based study. Am J Trop Med Hyg. 2011;85(2):285-90. [crossref] [PubMed]
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Pollett S, Banner P, O’Sullivan MVN, Ralph AP Epidemiology, Diagnosis and Management of Extra-Pulmonary Tuberculosis in a Low-Prevalence Country: A Four Year Retrospective Study in an Australian Tertiary Infectious Diseases Unit. PLoS One. 2016;11(3):e0149372. [crossref] [PubMed]
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Sama JN, Chida N, Polan RM, Nuzzo J, Page K, Shah M. High proportion of extrapulmonary tuberculosis in a low prevalence setting: a retrospective cohort study. Public Health. 2016;138:101-107. Doi:10.1016/j.puhe.2016.03.033. [crossref] [PubMed]
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DOI and Others

DOI: 10.7860/JCDR/2022/53255.16488

Date of Submission: Nov 17, 2021
Date of Peer Review: Jan 03, 2022
Date of Acceptance: Apr 08, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 18, 2022
• Manual Googling: Apr 08, 2022
• iThenticate Software: May 30, 2022 (17%)

ETYMOLOGY: Author Origin

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