Miliary tuberculosis of the lymph nodes in a developing community

doi:10.15406/moji.2018.06.00225

MOJ

eISSN: 2373-4442

Immunology

Case Report Special Issue Lymphology & Phlebology

Miliary tuberculosis of the lymph nodes in a developing community

Wilson IB Onuigbo,¹

Verify Captcha

Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Please type the correct Captcha word to see email ID.

Okeke Simeon²

¹Enugu Specialist Hospital, Nigeria
²Iyi-enu Hospital, Ogidi, Nigeria

Correspondence: Wilson IB Onuigbo, Departments of Pathology and Surgery, Enugu, Nigeria

Received: January 01, 1971 | Published: November 16, 2018

Citation: Onuigbo W, Okeke S. Miliary tuberculosis of the lymph nodes in a developing community. MOJ Immunol. 2018;2(2):38. DOI: 10.15406/moji.2018.06.00225

Download PDF

Abstract

According to Merriam-Webster’s Collegiate Dictionary, “miliary” is a word indicating “having or made up of many small projections of lesions.” It exemplified with “miliary tuberculosis.” Previous personal research on tuberculosis of the lymph nodes among the Ibo ethnic group in Nigeria revealed 100 cases without any miliary case. Subsequently, as the next 162 cases were studied, only one was of the miliary type. Therefore, this is worthy of documentation.

Keywords: tuberculosis, lymph nodes, Ibos, miliary, rarity

Introduction

The Merriam-Webster’s Collegiate Dictionary defined “miliary” as a word indicating “having or made up of many small projections or lesions”.¹Moreover, this was exemplified with “miliary tuberculosis.” Incidentally, previous work among the Ibo ethnic group,² using 100 cases of lymph nodes was unavailing in this respect.³ Thereafter, working on the next 162 cases exposed one miliary example. Therefore, it merits documentation.

Case Report

NR, a 25-year-old Ibo man, consulted Dr Okeke at the Iyi Enu Hospital, Ogidi Nigeria, with a 2 weeks’ history of vague abdominal pains which got worse 2 days with added vomiting. There was tenderness in the right iliac fossa. On exploration, multiple miliary lesions covered the entire visceral surfaces of the small and large intestines. The biopsy yielded several small nodular matted masses. On microscopy, the senior author (WO) found that both the lymph nodes and the mesentery exhibited granulomas in which caseation was apparent. Moreover, giant cells of both foreign body type and the Langhans type were apparent. Oddly, their ghost forms were noted in the caseous matter. There being no evidence of malignancy, miliary tuberculosis was diagnosed.

Discussion

This case confirms the importance of the establishment of histopathology data pool as was hypothesized for facilitating epidemiological analysis by authors based in Birmingham (UK) in 1980.⁴ In other words, the lone pathologist working at the Eastern Nigerian Regional Pathology Laboratory at the State Capital, Enugu, was firmly positioned to diagnose the miliary form of tuberculosis. Incidentally, the mesenteric deposits do not negate the importance of the lymph node miliary deposits. This is because an entire survey limited to the peritoneum did not reveal any miliary deposits on it.⁵ Incidentally, there was once some debate as to whether distant doctors could even benefit from a central laboratory.⁶ This has been floored twice from this Regional Laboratory.^7,8Indian associates, on considering that miliary tuberculosis requires a new look at an old foe, included biopsy of the lymph nodes.⁹Fellow Indians generalized on “biopsy from various organ sites”.¹⁰ From Turkey, biopsy evaluation was also commended.^11,12 Therefore, the present Nigerian biopsied case is deemed to be worthy of documentation.