A clinical case of atypical complicated miliary tuberculosis in a patient without HIV or medicinal immunosupression

Abstract

The aim of the study is to analyze a clinical case of atypical complicated miliary tuberculosis in a young man without HIV-infection or medicinal immunosuppression.

Materials and methods. The article presents a clinical case of atypical miliary tuberculosis, complicated by spontaneous pneumomediastinum and subcutaneous emphysema of the neck and chest, in a 24-year-old young man, a citizen of Uzbekistan, a 4th year university student in St. Peters- burg, who does not have HIV-infection and did not receive immunosuppressive therapy.

Results. The disease developed in a patient in the time of peace on the background of a long-term inadequate unbalanced diet, pro- tein insufficiency and alimentary dystrophia with a loss of about 30% of the initial body weight. It was characterized by unusual clinical manifestations in the form of exudative and caseous-necrotic inflammatory reactions, destruction of lung tissue, tissue of intrathoracic lymph node and dis- ruption of the bronchus wall, development of complications — spontaneous pneumomediastinum and subcu- taneous emphysema of the neck and chest. Usually, the atypical miliary tuberculosis may occur in the conditions of immunodeficiency (HIV-infection or medicinal immunosuppression), cases have also been observed in wartime and under extreme famine conditions during the seige of Leningrad during WWII.

Conclusion. In this patient, in peaceful times, prolonged inadequate unbalanced nutrition, protein insufficiency and alimentary dystrophia with a loss of about 30% of the initial body weight led to decrease in the body’s resistance to infectious diseases, the development of miliary tuberculosis, and also to change in its clinical manifestations in the form of exudative and caseous-necrotic inflammatory reactions, destruction of respiratory tissues and the development of complications — spontaneous pneumomediastinum and subcutaneous emphysema.