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Unusual miliary tuberculosis presenting with generalized lymphadenopathy and abdominal involvement
R Köylü1, E Tozkoparan, Y Pabuşçu
1Department of Chest Diseases and Tuberculosis, Gülhane Military Medical Academy, Ankara, Turkey.
Summary
This case highlights tuberculosis presenting atypically with widespread lymphadenopathy and organ involvement, initially mimicking lymphoma. Prompt diagnosis and treatment led to full recovery, underscoring the importance of considering tuberculosis in complex cases.
Area of Science:
- Medical Diagnostics
- Infectious Diseases
- Radiology
Background:
- Tuberculosis (TB) is a prevalent infectious disease globally.
- Unusual presentations of TB can complicate differential diagnosis.
Observation:
- A young patient presented with constitutional symptoms (weight loss, dyspnea) and extensive lymphadenopathy.
- Imaging revealed generalized lymphadenopathy, miliary infiltrates, pleural effusion, and abdominal/splenic involvement.
- Initial Mantoux test was negative, and clinical suspicion pointed towards malignant lymphoma.
Findings:
- Sputum smears positive for mycobacteria confirmed tuberculosis.
- Cervical lymph node biopsy showed caseating granulomatous lymphadenitis, consistent with TB.
- Pleural fluid was transudative, likely due to lymphatic obstruction.
Implications:
- This case emphasizes the diagnostic challenges posed by extrapulmonary tuberculosis.
- Early recognition and appropriate anti-TB therapy are crucial for favorable outcomes.
- Clinicians should maintain a high index of suspicion for TB in patients with unexplained, widespread lymphadenopathy and organomegaly.