Fatal paradoxical cryptic miliary tuberculosis and immune reconstitution disease in a young non-HIV immunocompromised male patient: case report with autopsy findings

Vol. 55 No. 2 Suppl., 2014
This supplement was not sponsored by Outside Organizations.


Milena Adina Man, Oana Cristina Arghir, Sorin Man, Costin Teodor Streba, Mihai Olteanu, Mimi Nitu

Non-HIV immunocompromised patients may develop immune reconstitution inflammatory syndrome (IRIS) as an abnormal response to invading microorganisms, such as Mycobacterium tuberculosis (MTB). IRIS consists in a sudden change in the dominant T-helper responses to inflammation, which is not balanced by anti-inflammatory response, playing a critical role in microbial pathogenesis. A patient with restoration of host immunity during anti-tuberculosis treatment can become gravely ill with a paradoxical severe form of tuberculosis (TB) disease named TB immune reconstitution disease (IRD).The diagnosis of acute cryptic miliary TB is difficult and requires an accurate histopathology. We report a fatal association between a generalized lymphadenitis tuberculosis and IRD in a 34-year-old male patient, non-smoker, non-HIV immunocompromised, but with a previously co-morbid diabetes mellitus (DM) type I. The purpose of this report is to describe an unusual and rare case of a progressive extrapulmonary TB disease to a liver involvement, mimicking a hepatotoxicity secondary to anti-tuberculosis therapy. The diagnosis of disseminated miliary TB with cryptic pulmonary was confirmed later after performing necropsy. Formalin-fixed paraffin-embedded pulmonary and extrapulmonary miliary foci were processed for histology and stained with Hematoxylin and Eosin. This rare entity of cryptic miliary involvement of the lungs is described more in elderly than in young individuals. In the reported case, IRD induced a paradoxical progressive dissemination of TB lesions leading to death in a patient with an apparent uncomplicated form of lymphadenitis TB.

Corresponding author: Mimi Nitu, Associate Professor, MD, PhD; e-mail: dr_nitumimi@yahoo.com

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Laura Mihaela Trandafir, Sandu Gabriel Aprodu, Doina Mihaila, Dana Teodora Anton Paduraru, Lacramioara Butnariu, Iulia Carmen Straticiuc Ciongradi

Congenital duodenal stenosis is one of the most common causes of neonatal obstruction, which is frequently associated with annular pancreas and Down syndrome. Ectopic pancreas is defined as an abnormally situated pancreatic mass that lacks contact with normal pancreas. Although the association between duodenal stenosis and annular pancreas is very common, the presence of an ectopic island of pancreas in such cases is very rare. We present a case of unusual association of duodenal stenosis, jejunal ectopic pancreas in a neonate with Down syndrome.

Corresponding author: Sandu Gabriel Aprodu, Assistant Professor, MD, PhD; e-mail: drpediatrie@yahoo.com

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