The analysis of the pathological material revealed granulomas in the intraepididymal tissue that manifest necrosis in the center (Figure 1a) along with non-necrotising small granulomas and granulomatous vasculitis affecting the medium- and small-diameter veins at multiple spots and causing necrosis on the blood vessel walls (Figure 1b)." Among the tests carried out for the purpose of differential diagnosis in the light of this result, only the
Mantoux test turned out positive.
Majority of the patients 44 (84.6%)
Mantoux test was positive, while in 8 (15.4%) patients
Mantoux test was negative.
He had been to various hospitals and investigations including blood complete picture, blood culture and sensitivity,
mantoux test and bone marrow aspiration and trephine biopsy were carried out.
Further investigations for the evidence of active tuberculosis showed negative results; the
Mantoux test result was negative (0 mm), and acid-fast bacilli direct stain as well as culture was negative.
In addition, a negative
Mantoux test cannot be relied upon to exclude the diagnosis, as the
Mantoux test has been negative in several biopsy-proven cases reported in the literature [9, 10].
The
Mantoux test (before immunosuppressant therapy) was negative.
Systemic investigations included a Full blood count (FBC), Erythrocyte Sedimentation Rate (ESR), C-Reaction Protein (CRP), Liver Function Tests (LFTs), Renal Function Tests (RFTs),
Mantoux Test, Angiotensin converting enzyme (ACE) level, Toxoplasma test, Anti Nuclear Antibodies (ANA), Rheumatoid Factor (RF), and Venereal Disease Research Laboratory test (VDRL).
Routine tests including complete blood count, erythrocyte sedimentation rate (ESR),
Mantoux test (purified protein derivative skin test), chest radiography, transnasal fiberoptic laryngoscopy, cervical and abdominal ultrasound, and sputum examination for acid-fast bacilli were also performed in all of the patients.
Serologic data concerning active or previous infections due to HBV (HBsAg, HBsAb, and HBcAb), HCV (HCVAb), EBV (VCA-IgG), VZV (VZV-IgG), CMV (CMV-IgG), and TBC (
Mantoux test and/or QuantiFERON-TB Gold test and/or chest X-ray) (
Mantoux test: tuberculin units of purified protein derivative, Tubertest, Sano Pasteur, MSD, Lyon, France; QuantiFERON-TB Gold test: QuantiFERON-TB Gold, Qiagen, Hilden, Germany) were collected.
Her pulmonary TB work-up including chest X-ray, sputum acid fast bacilli (AFB), and
Mantoux test was negative.
Additional data indicate that it may exhibit better sensitivity than
Mantoux test in confirming ocular tuberculosis [12].