Tehran University Medical Journal

Background: Association of Addison's disease with connective tissue diseases such as scleroderma and Sjogren have been rarely reported. Anti-centromere antibody (ACA) has been associated with exocrine gland dysfunction in anti-Ro, anti-La negative Sjogren’s syndrome and may be one of the causes of xerostomia in community. The purpose of this article was to introduce a rare case of scleroderma-Sjogren intermediate phenotype with positive anti-centromere antibody in a known case of Addison’s disease admitted for dental caries and xerostomia.
Case Presentation: A 29-year-old woman with Addison’s disease referred to a dental clinic due to recurrent dental caries. Addison’s disease was confirmed by low basal serum cortisol level and unresponsive serum cortisol level to adrenocorticotropin hormone (rapid ACTH stimulation test). Signs of xerostomia, xerophthalmia, Raynaud’s phenomenon, gastro-esophageal reflux, masked face, osteoporosis, positive anti-centromere antibody, negative anti-Ro and anti-La antibodies and failure to match the pathology of the minor salivary gland of lip with Sjogren's disease were found. The diagnosis of scleroderma-Sjogren intermediate phenotype was raised with considering some of the symptoms of scleroderma and Sjogren and not the exact classification criteria for each of these two diseases. Hydroxychloroquine, fluoride and Biotene® mouthwash (Laclede, Inc., CA, USA) (oral moisturizing saliva), chewing gum containing xylitol plus artificial tear droplet was prescribed. Drinking plenty of fluids was recommended. Due to gastroesophageal reflux and osteoporosis, Pantoprazole and CinnoPar® (Cinnagen, Iran) (parathyroid hormone analogue) plus calcium and vitamin D supplements was administered. Regarding adrenal insufficiency, Prednisolone and Fludrocortisone were continued.
Conclusion: For evaluation of recurrent dental caries, especially in patients with autoimmune disease, anti-centromere antibody may be useful to identify the cause of dry mouth, as well as early detection of limited scleroderma or scleroderma-Sjogren intermediate phenotype.

Background: Molecular detection has recently been proposed by nucleic acid amplification, known as polymerase chain reaction (PCR). The aim of this study was to compare the diagnostic method of smear and polymerase chain reaction with culture in terms of sensitivity, specificity, positive and negative predictive value in the diagnosis of pulmonary tuberculosis.
Methods: In this cross-sectional study, sputum samples were collected from 58 patients with suspected pulmonary tuberculosis referred to Ghaem Hospital in Mashhad from the beginning of April 2017 to the end of March 2018. The samples were delivered to the laboratory in less than 72 hours. Patients were sampled for three times. Bronchoscopy and Broncho alveolar lavage were performed in patients who were unable to produce sputum. The smear test was reported by Ghaem’s Laboratory after 24 hours. In our study, the culture method was considered as the gold standard and the sensitivity and specificity of the PCR methods and smear were compared with it.
Results: Patients ranged in age from 18 to 89 years. Among 58 suspected pulmonary tuberculosis, the method of cultivation confirmed the presence of the disease in 25 cases (43.1%). However, with smear, the presence of the disease has been proved in 27 patients (46.6%) and with the method of PCR in 24 patients was (41.4%). Sensitivity of smear in the diagnosis of pulmonary tuberculosis was (100%), and its specificity was 93.9%, the positive predictive value of this test was (92.6%) and the negative predictive value was (100.0%). The sensitivity of the PCR method in diagnosis of pulmonary tuberculosis was 88.0% and its specificity was 93.9%. The positive predictive value of this was (91.7%) and the negative predictive value was (91.2%).
Conclusion: In this study, between the two methods of smear and polymerase chain reaction, the acid fast smear method was more sensitive to the diagnosis of pulmonary tuberculosis than the polymerase chain reaction and the specificity of both methods were the same.