PMID- 24970001
OWN - NLM
STAT- MEDLINE
DCOM- 20150416
LR  - 20140627
IS  - 2066-8279 (Electronic)
IS  - 1220-0522 (Linking)
VI  - 55
IP  - 2
DP  - 2014
TI  - Fatal paradoxical cryptic miliary tuberculosis and immune reconstitution disease 
      in a young non-HIV immunocompromised male patient: case report with autopsy 
      findings.
PG  - 453-7
AB  - 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.
FAU - Man, Milena Adina
AU  - Man MA
AD  - University of Medicine and Pharmacy of Craiova, Romania; dr_nitumimi@yahoo.com.
FAU - Arghir, Oana Cristina
AU  - Arghir OC
FAU - Man, Sorin
AU  - Man S
FAU - Streba, Costin Teodor
AU  - Streba CT
FAU - Olteanu, Mihai
AU  - Olteanu M
FAU - Nitu, Mimi
AU  - Nitu M
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - Romania
TA  - Rom J Morphol Embryol
JT  - Romanian journal of morphology and embryology = Revue roumaine de morphologie et 
      embryologie
JID - 9112454
SB  - IM
MH  - Adult
MH  - Autopsy
MH  - Fatal Outcome
MH  - HIV Seronegativity
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*complications/pathology
MH  - Male
MH  - Tuberculosis, Miliary/*complications/pathology
EDAT- 2014/06/28 06:00
MHDA- 2015/04/17 06:00
CRDT- 2014/06/28 06:00
PHST- 2014/06/28 06:00 [entrez]
PHST- 2014/06/28 06:00 [pubmed]
PHST- 2015/04/17 06:00 [medline]
AID - 550214453457 [pii]
PST - ppublish
SO  - Rom J Morphol Embryol. 2014;55(2):453-7.