Anthracotic mediastinal lymphadenopathy: case report

We report the case of a male patient, known to have rheumatic mitral valve disease, who presented to us with huge mediastinal lymphadenopathy and dry cough. He was a life-time non-smoker and the only past medical history was his exposure to smoke during the Gulf war in 1991. This patient was in Kuwait during the Iraqi invasion and had a continuous exposure to the polluted environment. Mediastinoscopic lymph node biopsy confirmed the diagnosis of anthracotic reactive lymphadenopathy and excluded other causes. Anthracotic pigmentation is a common finding in mediastinal lymph node biopsies especially in smokers, but symptomatic huge lymphadenopathy was rarely reported. This observation and its correlation to the gulf war are also not reported in the literature

Miliary tuberculosis in Kuwait: clinical presentation, diagnosis and treatment outcome

To assess the demographic, clinical and laboratory features, methods of diagnosis, treatment and outcome in patients with miliary tuberculosis [TB] in Kuwait Retrospective [medical records review] Tuberculosis department, Al Rashed Allergy Center, Kuwait Thirty-four patients with miliary TB admitted from January 1996 to December 2005 Demographic features, clinical presentation, investigation results, treatment history and follow up records There were 22 male and 12 female patients; mean age 33 years. 91% were expatriates. Fever [91%], weight loss [88%], cough [82%], night sweats [61%] and hemoptysis [17%] were common presenting symptoms. Lymphadenopathy [35%], hepatomegaly [26%] and meningeal signs [12%] were seen. Anemia [65%], leucocytosis [21%], thrombocytopenia [6%], thrombocytosis [12%], raised liver enzymes [32%] and hypoalbuminemia [85%] were common laboratory findings. Sputum culture for Acid-Fast Bacilli [AFB] was positive in 64%. AFB culture was positive from cerebro-spinal fluid in three patients, lymph node in two, pus, endometrium, bronchial biopsy, liver biopsy, joint aspirate, ileal biopsy, urine, trans-bronchial biopsy and bronchial lavage in one case each. 73% were sensitive to all first line anti-TB drugs. Hepatitis [23%], hyperuricemia [9%], skin rashes [3%], nephropathy [3%] were the sideeffects of anti-tuberculosis drugs. One patient [3%] died, 56% were cured, 35% left the country or were deported, and 6% defaulted. One patient had relapse. Diagnosis of miliary TB could be confirmed by clinical features, radiological features and AFB culture, even when classical miliary patterns were not present. Anti-TB drugs were generally safe. Majority of patients were cured completely when followed up regularly