BackgroundExtrapulmonary tuberculosis is one of the great mimickers of medicine, and often masquerades as malignancy. As a result, patients may be referred to oncologists and surgeons for further evaluation and management, delaying the institution of appropriate anti-tuberculous drug therapy.Case presentationWe present the case of a 21 year old man with ...

We report a patient with chronic active hepatitis in whom one of the initial findings was retroperitoneal lymphadenopathy, detected by abdominal ultrasound examination. Extrahepatic presenting findings of chronic active hepatitis may include arthritis, urticaria, pleurisy and pericarditis, while abdominal ...

We report a case of a 38-year-old male who presented to us with a nodular swelling of the tongue with cervical lymphadenopathy suggestive of a malignancy. The lesion was diagnosed to be of tuberculous origin and the patient responded well to anti-tubercular chemotherapy. PMID:16568055

IntroductionIn cases of patients with disseminated lymphadenopathy, the differential diagnosis has to include both benign and malignant causes, including sarcoidosis, metastatic disease, lymphoma and, although rarely present, tuberculosis. Tuberculosis is still one of the most frequently occurring infectious diseases worldwide. However, disseminated mycobacterial lymphadenitis ...

Dermal tuberculous lesions were produced in rabbits by the intradermal injection of BCG. At various times after infection, anesthetized animals were perfused with a gelatin-colloidal carbon medium via the abdominal aorta. The capillary density of the nonn...

Kidney damage Lymphadenopathy (abnormalities of the lymph nodes) Obstructed vena cava Pancreatic cancer Portal vein obstruction (liver) Renal arterial obstruction Renal vein...

Kawasaki disease is a syndrome that usually occurs in infants and children. It is characterized by an exanthem, enanthem, fever, lymphadenopathy, and polyarteritis of variable severity. The present report describes cases in which an initial presentation of Kawasaki disease included abdominal and gastrointestinal symptomatology.

Mediastinal or Intra-abdominal Lymphadenopathy,; Pancreatic Masses,; Left Adrenal Masses,; Gastrointestinal Submucosal Lesions, and; Liver Masses

The authors report their experience with magnetic resonance imaging (MR) in 20 patients with CT-proved lymphadenopathy of the abdomen and pelvis. Signal intensity from abnormal nodes was intermediate between fat and muscle and was shown best in the spin-echo mode. Abnormal nodes were identified by their increased size and other morphological changes rather than by tissue ...

Abdominal computed tomography (CT) was performed in 31 patients with Kaposi sarcoma (KS) related to acquired immunodeficiency syndrome (AIDS), three patients with classic KS, and 12 patients with the newly described lymphadenopathy syndrome (LNS). The frequency, distribution, and appearance of lymphadenopathy and splenomegaly were ...

We report a 13-year-old boy who was detected to have an abdominal mass on ultrasonography. A possibility of tuberculous lymph nodes was considered in view of history of pain, low fever, and anorexia. Histology of the excised mass showed complete gastric duplication cyst. PMID:16204909

Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as an important tool for the diagnosis and staging of lung cancer but its role in the diagnosis of tuberculous intrathoracic lymphadenopathy has not been established. The aim of this study was to describe the diagnostic utility of EBUS-TBNA in patients with ...

Children with evidence of tuberculous disease registered at the TB Clinic, Institute of Child Health, Madras during the years 1977 to 1992 were analyzed. Progressive primary complex, is the commonest thoracic form of tuberculosis while tuberculous meningitis is the commonest extra thoracic form. The overall prevalence of various clinical forms of ...

Thirty cases of abdominal tuberculosis were diagnosed over an 18-year period, 26 being in immigrants; the mean age at presentation was 33 years. There were 25 cases of tuberculous peritonitis, two of tuberculous mesenteric lymphadenitis, and one each of gastric tuberculosis, colonic tuberculosis and tuberculous ...

A 3-wk-old male, with abdominal distention and severe hypoproteinemia from poor nutrition, underwent a study that showed a persistent diffuse abdominal uptake of Ga-67 citrate, indicating pyogenic or tuberculous peritonitis. However, there were no corresponding clinical or laboratory findings. After a 1-wk course of hyperalimentation ...

Abdominal CT is often performed for the staging of lymphoma. Retroperitoneal lymphadenopathy is the most common abnormality identified, but various extranodal sites of lymphomatous involvement have been reported, especially in non-Hodgkin lymphoma. Renal involvement is not rare, but peripelvic or periureteral involvement in the absence of renal parenchymal ...

A thirty-six year old male patient presented with dyspnea, right-sided chest pain, night sweats and intermittent fever. He has a history of ankylosing spondylitis treated with tumour necrosis factor-alpha (TNF-alpha) antagonist (infliximab). Computed tomography of the chest showed mediastinal lymphadenopathy, right-sided pleural effusion, and atelectasis. The pleural fluid was ...

A 62-year-old Japanese man was referred to our hospital because of general fatigue. Abdominal ultrasonography and enhanced computed tomography scanning revealed many enlarged lymph nodes, mainly around the pancreas tail and the hilus of the spleen. Neither blood examination nor gallium scintigraphy revealed any abnormalities, whereas the diagnostic tuberculin test was strongly ...

We report a case of systemic phaeohyphomycosis in a 13-year old girl. The clinical presentation was with fever, weight loss, cholestatic jaundice with hepatosplenomegaly and generalized lymphadenopathy. The patient was diagnosed initially as tuberculous adenitis and was on antituberculous therapy, but with worsening of symptoms. Lymph node and liver biopsy ...

Isolated tuberculous liver parenchymal and subcapsular abscesses are unusual,^but an abdominal wall abscess secondary to a tubercular liver abscess is extremely rare. To our knowledge, there is only one reported case of an abdominal wall abscess occurring secondary to a subcapsular liver abscess. We report the first documented case of ...

Background:Retrospective observation analysis to evaluate the outcome of six month treatment regimen, CAT-III and CAT-I, for all patients diagnosed with tubercular lymphadenopathy at M.G.M. Medical College and M.Y. Hospital, Indore, India from January 2006 to December 2008.Materials and Methods:Out of 3158 cases of tuberculosis, there were 337 (10.67%) lymphnode cases; 31 ...

BackgroundGranulomatous inflammation has been previously reported in association with cancer. Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is a new minimally invasive test for investigating mediastinal lymphadenopathy. The identification of granulomatous inflammation by EBUS-TBNA and the clinical implications of such detection in a series of ...

BackgroundKikuchi-Fujimoto's disease (KFD), also called histiocytic necrotizing lymphadenitis, is a rare, idiopathic and self-limited condition usually characterized by cervical lymphadenopathy and fever, most often affecting young patients. Aetiology is unknown. Differential diagnosis includes mainly malignant lymphoma, tuberculous lymphadenitis and ...

IntroductionTuberculous psoas abscess was usually associated to complicate Pott's disease, but it can also be secondary to direct extension from other adjacent structures or haematogenous spread from an occult source. However, the occurrence of this entity as the presenting manifestation of tuberculosis, without evidence of active infection elsewhere, has been seldom ...

Aorto-enteric fistulas are rare and are associated with significant mortality. Infective causes usually occur within the setting of post-graft repair. Aorto-enteric fistula secondary to tuberculosis is extremely rare despite the high prevalence of this infection. Unfortunately, the diagnosis is often not suspected until surgery or at post-mortem. We report a case of an elderly Malay man presenting ...

A 22-year-old Nepali man presented with a 2-month history of fever, ill health, anorexia, loss of weight and diarrhoea. Apart from an ill-defined lower abdominal mass, physical examination was unremarkable. Investigations showed the picture of malabsorption syndrome with no evidence of structural gastro-intestinal tract involvement on barium meal, small bowel and large bowel ...

A case of tuberculous peritonitis complicating continuous ambulatory peritoneal dialysis (CAPD) in a 37-year-old man who presented with fever, abdominal pain, and a malfunctioning Tenckhoff catheter is reported. The patient was initially treated for presumed bacterial peritonitis but remained febrile and had persistent abdominal pain ...

For studying abdominal tuberculosis (TB) in Ahmadi, files off all patients admitted to our hospital with abdominal TB over 15 years (1981-1996) were reviewed. Nineteen patients are reported here. Young adults were predominant in our study. The non-Arab Asians were the most frequently affected group in relation to their population in Ahmadi, and Kuwaitis ...

Obstruction of blood flow through the inferior vena cava and portal vein may produce venous collaterals. These include the paravertebral venous system and its communications with the ascending lumbar veins and azygous/hemiazygous system; gonadal, periureteric, and other retroperitoneal veins; abdominal wall veins; hemorrhoidal venous plexus; and the portal venous system. The ...

A case of non-Hodgkin's lymphoma of the abdomen studied by gallium SPECT imaging is reported. The tomographic slices accurately demonstrated the location of residual disease after chemotherapy in the region of the transverse mesocolon. Previous transmission CT had shown considerable persistent retroperitoneal lymphadenopathy, but was not helpful in determining the ...

Disseminated mycobacterial infection after Bacille Calmette-Gu�rin (BCG) vaccination is a rare disorder, usually presenting with fever, weight loss, anemia, lymphadenopathy and hepatosplenomegaly. We report a case of disseminated BCG infection in a 28-month-old girl with prolonged fever and abdominal mass due to retroperitoneal abscess. Appropriate ...

IntroductionIn some particular endemic area, it is not uncommon to see patients with tuberculosis pericarditis. However, it takes a period of time from tuberculous pericarditis to constrictive pericarditis. There is still no report of tuberculous constrictive pericarditis concurrent with active pulmonary TB infection in a patient without previous pulmonary ...

Ferret systemic coronavirus infection (FSCV) is a systemic disease in ferrets that clinically and pathologically resembles the dry form of FIP. The present study describes abdominal imaging features of 11 ferrets with FSCV. Abdominal survey radiographs were available for eight ferrets and ultrasound examination for all cases. Loss of lumbar musculature, ...

A case of 14-year-old girl is reported who presented with features of tuberculous subacute intestinal obstruction. Exploratory laparotomy revealed a urachal cyst associated with pseudomyxoma peritonei (PMP). Histopathology confirmed a moderately differentiated mucin secreting adenocarcinoma of urachal cyst associated with PMP. The adenocarcinoma of urachal cyst associated with ...

M. tuberculosis is a possible cause of uveitis; the diagnosis is often difficult. The aim of this study is to evaluate, in this context, the application of an interferon gamma assay, the SpotTB�. The prospective study, in patients presenting with uveitis without obvious cause and not resolving with local treatment, compared the therapeutic approach (giving antituberculous treatment or not) with ...

Tuberculosis and sarcoidosis share similarity in histopathologic findings and clinically occur in association with each other occasionally. Tuberculosis should always be ruled out before the diagnosis of sarcoidosis. But, the diagnosis is often complicated, especially in extrapulmonary cases. Here we present a case of bilateral vitreous hemorrhage with uveitis. Ocular sarcoidosis was initially ...

Sarcoidosis is an idiopathic, multisystem disease that rarely involves the genitourinary tract. Here we present an unusual case of testicular sarcoidosis with extensive lymphadenopathy that mimicked a metastatic testicular tumor. A 27-year-old male presented with a palpable right testicular mass accompanied by multiple palpable inguinal lymph nodes. The scrotal ultrasound ...

Twenty-five patients with nonseminomatous germ cell carcinoma of the testis underwent CT and nuclear magnetic resonance (NMR) of the retroperitoneum followed by radical retroperitoneal lymph node dissection for surgical proof of metastatic disease. Computed tomography correctly predicted the presence or absence of adenopathy in 88% and assigned the correct stage in 84%. Nuclear magnetic resonance ...

Amyloid material on lymph node cytology smears can mimic caseous necrosis. We report one such case where a 50-year-old lady presented with a nasal mass and cervical lymphadenopathy. Fine needle aspiration cytology smears of the cervical lymph node were interpreted as tuberculous lymphadenitis based on the presence of an occasional epithelioid cell and ...

We report the unusual case of a patient with G3 pT1 transitional cell carcinoma (TCC) of the bladder, which was treated with repeated transurethral resection and maintenance intravesical Bacillus Calmette-Gu�rin (BCG) therapy. At 30 months follow-up, a symptomatic, solitary iliac lymph node mass was identified and biopsied. Histology demonstrated granulomatous tissue only, in the absence of any ...

Introduction: Tuberculous appendix is surprisingly rare, even in countries where this infection is common. We report our experience with tuberculous appendix over a 15-year period. Methods: A search for cases of tuberculous appendix was conducted from January 1995 to December 2009 on the databases of the National Tuberculosis Centre ...

A patient with immunoblastic lymphadenopathy (IL) had an unusual course of illness, with frequent episodes, over a 20-month period, of chills, fever, abdominal pain, hepatosplenomegaly and weight loss. The episodes were short-lived and many resolved spontaneously. Eventually generalized lymphadenopathy and profound monoclonal IgG ...

A 33-year-old man with myelodysplastic/myeloproliferative disease underwent allogeneic bone marrow transplantation. Around day 80 post-transplant, he complained of abdominal pain and diarrhea. Colonoscopy and esophagogastroduodenoscopy findings were unremarkable. Double-balloon enteroscopy revealed atrophic villi and mild erosions localized in the small intestine. Histological ...

Computed tomography of the abdomen and pelvis is frequently performed for the staging of abdominal and pelvic lymphoma. Certain limited CT protocols have been nearly as accurate as more complete examinations at defining the extent of lymphadenopathy and the response to therapy, with the advantages of decreased scanning time and patient radiation dose. The ...

AIM: To evaluate the specific computed tomography (CT) imaging criteria for differentiating tuberculosis involving the small bowel mesenteric lymph nodes from lymphomas.METHODS: We retrospectively reviewed the anatomic distribution, CT enhancement patterns of lymphoma in 18 patients with mesenteric tuberculosis and 22 with untreated non-Hodgkin�s lymphomas (NHL) involving small bowel mesentery ...

Culture-negative endocarditis is most often the result of prior antimicrobial therapy. Tropheryma whipplei is the etiologic agent of Whipple's disease, which is typically characterized by diarrhea, weight loss, and intra-abdominal lymphadenopathy. We present the case of a 48-year-old male with Whipple's endocarditis of the aortic valve who did not develop ...

Involvement of kidneys in disseminated lymphoma is common. Primary lymphoma of the kidney is rare and has varied imaging characteristics. Abdominal lymphadenopathy can result in encasement and narrowing of the retroperitoneal vessels occasionally causing thrombosis. We present a 12-year-old boy with renal lymphoma and inferior vena caval thrombus; discuss ...

Cryptococcus neoformans, a well-known pathogen of the immunocompromised host, is rarely reported as a cause of disseminated infection in the immunocompetent pregnant woman. Reported herein is the case of a young gravid woman, who initially presented with vague systemic symptoms that evolved into a disseminated cryptococcosis, which was resistant to standard parenteral antifungal therapy and ...

We report a 3-year-old boy who initially presented with abdominal pain and was subsequently found to have an esophageal perforation. The child did not respond to conservative management, and subsequent lymphadenopathy led to a lymph node biopsy demonstrating an anaplastic lymphoma kinase (ALK)+ anaplastic large cell lymphoma. Esophageal perforation and ...

A 54-year-old male presented at a previous hospital with abdominal pain, where the patient was diagnosed as having abdominal and retroperitoneal lymphadenopathies by CT scan, then, he was referred to our hospital for further examination. Upper gastrointestinal endoscopy showed a tumor formation in the second portion of the duodenum, ...

A communicating vein between the left renal vein and the left ascending lumbar vein has only rarely been reported in the imaging literature. There are very few reports of varicosity of this communicating vein. Nonetheless, awareness about this communicating vein is of utmost importance for surgeons performing aortoiliac surgeries and nephrectomies as it may pose technical difficulties during ...

In developing countries, where tuberculosis (TB) is still rampant, tuberculous lymphadenopathy (TB LAP) is one of the most common causes of LAP. Rapid diagnosis and adequate treatment are very important. As a primary diagnostic tool, fine needle aspiration cytology (FNAC) has provided an efficient alternative to excision. Cytologic diagnosis can be made ...

A 6-month-old little boy presented with fever and cervical lymphadenopathy for four days. On admission, he was found to have conjunctival congestion of both eyes, reddened and fissured lips, straw-berry tongue, macular rash at the trunk and erythematous change on the BCG injection site. The diagnosis of Kawasaki disease was made and aspirin therapy (100 mg/kg/day) was started. ...

A major diagnostic challenge to the evaluation of an incomplete intestinal obstruction is to distinguish between infectious and malignant etiologies. We present a case of an elderly woman complaining of abdominal pain accompanied with nausea and vomiting, and failure to pass gas or stools. Anti-tuberculosis drugs were used to relieve her abdominal pain, ...

Forty-eight patients were scanned with /sup 111/In-chloride in an attempt to identify the cause of fever. Fifteen true positive scans, 30 true negatives, and 3 false negatives were found. Of the 15 true positives, 7 cases of abdominal or pelvic abscess, and 8 cases of alcoholic hepatitis were detected. The 3 false negatives included: (1) an abscess in the anterior ...

ObjectiveWe wanted to describe the computed tomography (CT) findings of gallbladder tuberculosis (TB) and to correlate them with pathologic findings.Materials and MethodsThere were seven patients (M:F = 3:4; mean age, 46.3 years; age range, 32 to 78 years) in whom gallbladder TB was eventually diagnosed. All of them underwent cross-sectional imaging with CT, a pathologic examination and a ...

Tuberculosis, usually extrapulmonary, is often associated with AIDS but tuberculous pericarditis is a rare manifestation in this group. We report three patients with tuberculous pericarditis as the first manifestation of AIDS. PMID:7789389

... 1, January 1974 Rifampicin Serum Level in Egyptian Tuberculous Patients ... Ii Page 5. Rifampicin Serum Level in Egyptian Tuberculous Patients: ...

Malignant lymph nodes in the neck include metastases and lymphoma. Cervical nodal metastases are common in patients with head and neck cancers, and their assessment is important as it affects treatment planning and prognosis. Neck nodes are also a common site of lymphomatous involvement and an accurate diagnosis is essential as its treatment differs from other causes of neck ...

AbstractMalignant lymph nodes in the neck include metastases and lymphoma. Cervical nodal metastases are common in patients with head and neck cancers, and their assessment is important as it affects treatment planning and prognosis. Neck nodes are also a common site of lymphomatous involvement and an accurate diagnosis is essential as its treatment differs from other causes of neck ...

Fine needle aspiration biopsy (FNAB) offers a simple outpatient technique for specimen collection in child tuberculosis suspects with peripheral lymphadenopathy. To perform FNAB with mycobacterial culture on an outpatient basis requires use of a sterile transport medium to facilitate bedside inoculation, maintain organism viability and reduce contamination risk en route to the ...

Disseminated infections with hemophagocytic syndrome caused by non-tuberculous mycobacteria (NTM) are rare. A 60-year-old woman, who presented with fever, chills, anorexia, and right upper quadrant pain, was admitted to our hospital. Hepatosplenomegaly, pancytopenia, elevated liver aminotransferases, and hyperferritinemia were noted after admission. A gallium scan and chest ...

We present a case of malignant mesothelioma of the peritoneum with massive direct invasion to the liver in a 58-year-old Japanese woman. She had no history of asbestos exposure or other malignancies. Abdominal computed tomography revealed one 8-cm intrahepatic mass adjacent to the abdominal wall with peritoneal thickening, multiple smaller nodules in the ...

IntroductionTuberculosis is still a serious infection among recipients of renal transplants. Although the ileocecal region is the most affected part in intestinal tuberculosis, acute tuberculous appendicitis is quite a rare entity. We report a case of concomitant pulmonary tuberculosis and tuberculous appendicitis in a recipient of a renal transplant.Case ...

Abstract and IntroductionAbstractTuberculoma of the liver is rare in an immunocompetent individual. We report a 26-year-old man with upper abdominal pain, abnormal liver function, and raised inflammatory markers. Abdominal computed tomography (CT) scan revealed a mixed attenuation lesion measuring 6 � 5 cm occupying most of the left lobe of the liver. ...

... Title : THE REACTIVITY OF TUBERCULOUS SKIN AREAS TO TUBERCULIN. Corporate Author : ARMY BIOLOGICAL LABS FREDERICK MD. ...

... A tuberculous allergen was separated from tuberculosis mycobacteria, brucellosis allergen from brucelli, and dysentery diagnosticum from ...

Tuberculous lymphadenitis is the most common cause of extra-pulmonary tuberculosis (TB) in developing countries. Lymphadenitis caused by non-tuberculous mycobacteria (NTM) requires consideration, particularly in immunocompromised patients and children in developed countries. Fine-Needle Aspiration Biopsy (FNAB) offers a valuable specimen collection ...

We present the case of a 20-year-old male who had a non-traumatic soft tissue lesion (4 x 3 cm) with recurrent discharge at his right posteromedial antebrachial muscles; the patient underwent surgery twice, and antibiotic therapy was administered, but no cure was achieved with these treatments. The patient underwent surgery at our medical center. There was no history of pulmonary, ...

Many malignant processes cause abdominal lymphadenopathy, and computed tomography (CT) has become the primary modality for its detection. A lymph node is considered enlarged (swollen) if it is more than 1 centimeter in diameter. Which lymph nodes are swollen depends on the type of disease and the body parts involved. Identifying their locations is very ...

Schistosomiasis is a parasitic infection endemic in 74 resource-poor nations that affects approximately 200 million people. Schistosomes are water-borne flatworms or blood flukes that enter the human body through the skin. Some symptoms of schistosomiasis include fever, arthralgias, abdominal pain, bloody diarrhea, and hematuria. Ultimately, patients develop heptosplenomegaly, ...

An adult female white-tailed deer (Odocoileus virginianus) with a history of shaking, ataxia, and severe debilitation was submitted for examination. Macroscopic lesions included severe emaciation, severe abdominal and mesenteric lymphadenopathy, and several rumen-associated masses. Microscopically, the ruminal masses and lymph nodes were infiltrated by ...

IntroductionCardiac involvement in malignant lymphoma is one of the least investigated subjects in oncology. This article reports a case of cardiac involvement in Hodgkin's lymphoma which presented as heart failure.Case presentationWe report the case of an 8-year-old Afghan girl with Hodgkin's lymphoma. The disease presented with systemic signs and symptoms, including ...

The abdominal and pelvic computed tomographic examinations in 28 patients with Crohn disease were analyzed and correlated with conventional barium studies, sinograms, and surgical findings. Mucosal abnormalities such as aphthous lesions, pseudopolyps, and ulcerations were only imaged by conventional techniques. Computed tomography proved superior in demonstrating the mural, ...

Castleman disease (CD) is a rare lymphoproliferative disorder of unknown etiology with different clinical manifestations. A previous healthy 50 year-old man was hospitalized for right upper quadrant (RUQ) abdominal pain. He had jaundice and a 1 cm-sized lymph node in the right supraclavicular area. Pancreas and biliary computed tomography (CT) showed masses at the right renal ...

Many malignant processes cause abdominal lymphadenopathy, and computed tomography (CT) has become the primary modality for its detection. A lymph node is considered enlarged (swollen) if it is more than 1 centimeter in diameter. Which lymph nodes are swollen depends on the type of disease and the body parts involved. Identifying their locations is very ...

A 62-year-old man was hospitalized in March 1990 due to upper abdominal discomfort and anorexia. The chest X-ray revealed an upper anterior mediastinal tumor, and abdominal ultrasound showed lymphadenopathy. Endoscopic examination of the stomach revealed a large, irregular ulcer, which was histologically confirmed to be malignant ...

A 55-year-old man was admitted to our hospital because of prolonged consciousness disturbance after generalized convulsions. He had been afflicted with chronic inflammatory symptoms since 43 years of age, while multiple abdominal lymphadenopathy with a high level of serum IL-6 was revealed at the age of 53. FDG-PET/CT showed hypermetabolism in the left ...

Tuberculosis (TB) infection is still common today and remains an important cause of morbidity and mortality. Abdominal TB is one of the most prevalent forms of extrapulmonary manifestations, and collectively refers to gastrointestinal, splenic, pancreatic, hepatobiliary and abdominal lymphadenopathy involvement. The manifestation can ...

Fat stranding adjacent to thickened bowel wall seen at computed tomography (CT) in patients with acute abdominal pain suggests an acute process of the gastrointestinal tract, but the differential diagnosis is wide. The authors observed "disproportionate" fat stranding (ie, stranding more severe than expected for the degree of bowel wall thickening present) and explored how ...

We report a case of acute Epstein-Barr virus (EBV) infection in which the clinical syndrome and pattern of F-18-2-fluoro-2-deoxy-D-glucose (FDG) uptake mimicked malignant lymphoma. A 53-yr-old man presented with 2 wk of high fevers, night sweats, sinus congestion and severe fatigue. The patient was treated for 1 wk with broad-spectrum antibiotics for acute sinusitis without any improvement. ...