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Miliary tuberculosis with unusual matted giant mesenteric lymph nodes
P Viriyavejakul1, V Sirikulchayanonta
1Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Summary
This case study highlights miliary tuberculosis in an infant presenting with fever and poor feeding. Unusual giant mesenteric lymph nodes were found, emphasizing the need to differentiate them from pediatric tumors.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pathology
Background:
- Miliary tuberculosis (TB) is a severe disseminated form of Mycobacterium tuberculosis infection.
- Pediatric TB presents unique diagnostic challenges, often mimicking other childhood illnesses.
- Mesenteric lymphadenopathy can occur in TB but giant, matted nodes are atypical.
Observation:
- A 10-month-old female infant presented with two months of prolonged fever and poor feeding.
- Chest X-ray revealed a miliary pattern, and sputum was positive for acid-fast bacilli.
- Autopsy revealed disseminated miliary TB and unusually large, matted mesenteric lymph nodes (10x6x5 cm).
Findings:
- The infant succumbed to pneumomediastinum and pneumopericardium.
- Post-mortem examination confirmed widespread miliary tuberculosis in major organs.
- Numerous acid-fast bacilli were identified, indicating a high bacterial load.
Implications:
- Large, palpable mesenteric lymph nodes in infants with suspected miliary TB require careful evaluation.
- These findings underscore the importance of considering TB in pediatric cases with unexplained fever and lymphadenopathy.
- Accurate differentiation from pediatric tumors is crucial for appropriate management and improved outcomes in disseminated TB.