Clinical case of specific generalized lymphadenitis complicated by miliary tuberculosis of lungs
Journal Title: Туберкульоз, легеневі хвороби, ВІЛ-інфекція - Year 2019, Vol 0, Issue 3
Abstract
Adolescent A., aged 15 years and 10 months, was admitted to the Department of Oncohematology of the Regional Children’s Clinical Hospital in IvanoFrankivsk urgently on 23rd of March, 2018; he was in a difficult clinical condition with generalized and conglomerate increase of many groups of peripheral lymphatic nodes with suspicion of lymphogranulomatosis. After a comprehensive examination and an open biopsy of the anteriorcervical lymph node rightward, on March 27th, 2018, granulomatous specific lymphadenitis of tubercular aetiology was confirmed pathohistologically. On April 5th, 2018, the patient was transferred for the treatment to the Children’s Department of the RPC (Regional Phthisiopulmonology Centre) with the FDPTB (First Diagnosed Primary Tuberculosis) (April 6th, 2018) of the lymph nodes, the generalized form, Destruction — MBT (Mycobacterium tuberculosis) — M– C (Culture)– Resistance 0 Histology+ (March 27th, 2018) Category 1 Cohort 2 (2018). He received antimycobacterial therapy H0.3, R0.3, Z1.5, Lfx0.5. In connection with the maintenance of the elevated level of several OncoMarkers in peripheral blood, he was distantly consulted by leading specialists of the Kyiv State Institution «National Institute of Phthisiology and Pulmonology named after F.H. Yanovsky of the AMS of Ukraine» on May 10th, 2018. Diagnosis of specific lymph nodes’ damage is confirmed, it is recommended to strengthen the treatment scheme with kanamycin. Having received the 90 doses of medicines, were noted: positive clinical dynamics, reduction of the size and conglomerate of peripheral lymph nodes and their absence in the retroperitoneal space according to the ultrasound study. On July 13th, 2018, the patient was discharged from the hospital for the outpatient treatment. After completing of the 120 doses of antimycobacterial medicines, on August 2nd, 2018, the miliary pulmonary tuberculosis was detected on the control MSCT (MultiSpiral Computed Tomography), and therefore the patient was rehospitalized with FTPTB (Failure of Treatment of Primary Tuberculosis) (August 6th, 2018) of the lymph nodes, generalized form Destruction– MBT– M– C– Resistance 0 Histology + (March 27th, 2018), complicated by miliary dissemination Category 2 Cohort 3 (2018). Treatment was continued according to the scheme 2H0.3, R0.45, Z1.5. E0.8, S0.75 with corticosteroid therapy with prednisolone of 20 mg with gradual decrease of the dose. On the control MSCT on October 4th, 2018, it was noted — positive dynamics — partial resorption of focal dissemination in both lungs, a significant reduction of the lymph nodes’ size of the mediastinum to normal. Subsequently, according to the MSCT on January 31, 2019, in both lungs throughout the course, an increasing focal (miliar) dissemination. February 20, 2019 a review of histological preparations of the biopsy of the lymph nodes of the neck, held consultation in the Kyiv State Institution «National Institute of Phthisiology and Pulmonology named after F.H. Yanovsky of the NAMS of Ukraine». The diagnosis of the specific nature of lymph nodes and lung lesions has been reconfirmed. On the 26th of February, 2019 according to the decision of the Central Medical Advisory Commission of DrugResistant TB of the IvanoFrankivsk Regional Phthisiopulmonology Centre in connection with the negative dynamics of a specific process in the lungs, it is recommended to register a clinical incidence in 4 categories with the diagnosis: RMDRTB (26.02.2019) pulmonary (miliary) Destruction– MBT– M– MG– C– Resistance 0 Histology + (March 27th, 2018), Category 4 (FTPTB) Cohort 1 (2019). The patient is prescribed treatment according to the scheme Cm0.6, Mfx0.4, Cs0.5, Pt0.5, Z1.6. Thus, the specific lymph nodes’ damage can clinically occur as a tumorous process. An important part in differential diagnosis is pathohistological study of the biopsy material of the lymph nodes. Further clinical observations, dynamic ultrasound study and MSCTexamination are necessary for controlling the course of the disease and correcting the treatment.
Authors and Affiliations
V. М. Zaiachuk, N. O. Hrytsiuk, I. Ya. Makoida, O. P. Melnyk-Sheremeta, O. B. Molodovets, L. A. Bubliuk, M. D. Shyika
Keywords
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- EP ID EP674896
- DOI 10.30978/TB2019-3-42
- Views 78
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