Spontaneous chylothorax revealing a mediastinal and abdominal lymph node tuberculosis.

Chylothorax is a rare manifestation of tuberculosis. We report a case of spontaneous chylothorax due to tuberculosis. A 62-year-old woman was admitted with fever, chest pain and dyspnea. Chest and abdominal computed tomography revealed a fluid collection with necrotic mediastinal and abdominal lymph nodes. Biopsy of lymph nodes by mediastinoscopy. The patient was treated with anti-tuberculosis medication. He is clinically improved and his pleural effusion also completely resolved.

[Pulmonary tuberculosis in smokers]. / Particularités de la tuberculose pulmonaire chez le tabagique.

INTRODUCTION: Tobacco smoking and tuberculosis (TB) are two major public health problems, and the former may affect the morbidity and mortality rates for the latter. This study sought to compare the clinical and radiologic aspects of pulmonary TB, as well as outcome, in smokers and nonsmokers. METHODS: This retrospective case control study examined the files of 90 patients in our pulmonary department with active pulmonary TB, 45 of them smokers and 45, nonsmokers. To analyze the seriousness of the radiologic lesions, we used a score based on the International Labour Organization classification for simple pneumoconiosis, rating lesions in 4 grades according to severity and extent. RESULTS: The mean age of the patients, all men, was 29 years (range: 16-50 years). Symptoms were similar in both groups, with no significant clinical or bacteriological differences between the two groups. However, the highest severity score was found in 81% of the smoking group compared with 15% of the nonsmokers (p<0.001). Moreover, after patients were cured, only smokers had severe radiological sequelae (13.8% versus 0%, p<0.05). CONCLUSION: Our study is one of the few to compare the radiological appearance of TB in smoking and nonsmoking patients. Smoking is associated with much more extensive and severe radiological TB lesions and sequelae and increases the risk of morbidity and mortality in TB patients. Therefore smoking prevention and cessation should be a priority in TB prevention programs.