Toshniwal Amit, Chaudhary Sumer, H Varun, Ghewade Babaji, Jain Alushika
Department of Respiratory Medicine, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India.
Department of Respiratory Medicine, Datta Meghe Medical College, Wanadongari, Nagpur, India.
IDCases. 2025 May 10;40:e02257. doi: 10.1016/j.idcr.2025.e02257. eCollection 2025.
Atypical forms of tuberculosis (TB) are gaining recognition, challenging traditional diagnostic criteria classically linked to chronic cough, lethargy, anorexia, evening pyrexia, and weight loss in immunocompromised patients. We present the case of a 23-year-old immunocompetent man from rural central India who developed unilateral pulmonary miliary TB with concurrent abdominal TB lymphadenitis. The patient presented with a two-month history of chronic cough and diffuse abdominal pain. Initial chest radiograph revealed unilateral, right-sided miliary opacities, while abdominal ultrasonography indicated mild circumferential bowel wall thickening and enlarged mesenteric lymph nodes. High-resolution computed tomography (HRCT) of the thorax showed multiple tiny centrilobular and peri-bronchovascular hyperdense nodules in the right lung, and contrast-enhanced computed tomography (CECT) of the abdomen confirmed necrotic mesenteric and para-aortic lymph nodes. Sputum microscopy was negative for acid-fast bacilli (AFB), but bronchoalveolar lavage (BAL) tested positive for AFB, and Truenat MTB PCR confirmed Mycobacterium tuberculosis (MTB) with a load of 6.3 × 10^2 CFU/mL. The patient was diagnosed with unilateral pulmonary miliary TB with abdominal TB lymphadenitis and was treated under the WHO Category I Directly Observed Treatment, Short-course (CAT 1 DOTS) regimen (2HRZE/4HRE) under the National Tuberculosis Elimination Program (NTEP). Symptomatic improvement was observed within four weeks, and a six-month follow-up confirmed clinical and radiological resolution. Despite India's high TB burden, unilateral miliary lung involvement with abdominal lymphadenitis remains rarely reported in immunocompetent hosts. This report emphasises the need for heightened clinical vigilance to optimise detection and management, contributing to global TB elimination efforts.
非典型肺结核（TB）正逐渐得到认可，这对传统诊断标准构成了挑战，传统诊断标准通常与免疫功能低下患者的慢性咳嗽、乏力、厌食、夜间发热和体重减轻相关。我们报告了一例来自印度中部农村的23岁免疫功能正常男性病例，该患者患有单侧肺粟粒性结核并伴有腹部结核性淋巴结炎。患者有两个月的慢性咳嗽和弥漫性腹痛病史。最初的胸部X线片显示单侧右侧粟粒状阴影，而腹部超声显示肠壁轻度环形增厚和肠系膜淋巴结肿大。胸部高分辨率计算机断层扫描（HRCT）显示右肺有多个微小的小叶中心性和支气管血管周围高密度结节，腹部增强计算机断层扫描（CECT）证实肠系膜和主动脉旁坏死淋巴结。痰涂片抗酸杆菌（AFB）检测为阴性，但支气管肺泡灌洗（BAL）检测AFB呈阳性，Truenat MTB PCR检测确诊为结核分枝杆菌（MTB），载量为6.3×10^2 CFU/mL。该患者被诊断为单侧肺粟粒性结核并伴有腹部结核性淋巴结炎，并在国家结核病消除计划（NTEP）下按照世界卫生组织第一类直接观察治疗短程化疗（CAT 1 DOTS）方案（2HRZE/4HRE）进行治疗。四周内观察到症状改善，六个月的随访证实临床和影像学均恢复正常。尽管印度的结核病负担很高，但免疫功能正常宿主中单侧粟粒性肺受累并伴有腹部淋巴结炎的情况仍鲜有报道。本报告强调需要提高临床警惕性，以优化检测和管理，为全球结核病消除努力做出贡献。
