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  • 1. AMYLOIDOSIS IN TUBERCULOSIS M. S. A GNIHOTRI AND S. R ASTOGI (From K.G.’s Medical College, Lucknow) The term amyliodpsis is used to describe a male who was emaciated, the subcutaneous fathyaline material which accumulates between being scanty. Examination of the thoracicparenchymatous cells and in connective tissue cavity revealed pleural adhsions on both sides.of organs. Association of amyloidosis and Cut surface of the lungs revealed cavities oftuberculosis is well known. Tuberculosis is a sizes varying from 2-4 cm in diameter. Theircommon cause of secondary amyloidosis walls were smooth. The surrounding lung(Anderson 1957; Mathur and Jhala 1964; parenchyma showed focal areas of caseation,Chitkara et al. 1965; Reddy and Parvathi, 1-2 mm in diameter. The tracheobronchial1968). Reddy et al. (1970) reported that in-cidence of amyloidosis in tuberculosis was19% in autopsies. Studies from western coun-tries have reported higher incidence of amy-loidosis in tuberculosis (Cohen 1943; Kozello1965; Yoshizumi, 1962). Recently, studiesdemonstrating changed pattern of amyloidosisin treated patients of tuberculosis have appearedin literature. Yoshizumi (1962) reported asharp decline in incidence of amyloidosis intuberculosis since the use of chemotherapy.Maltchik (1959) observed that amyloidosis in-volves lesser number of organs when it occursin chronic form of tuberculosis. We are reporting a treated patient ofbilateral pulmonary tuburculosis with secon-dary amyloidosis and miliary tuberculosis. Fig. 1Case Report P.A. view of chest showing bilateral infiltration with R.N., aged 35 years, male was admitted a doubtful cavity in the right mid zone.with complaints of cough with expectoration2 years, fever and occasional streaking of lymph nodes were enlarged. The small intes-sputum 11 years and generalised weakness 4 tines revealed multiple pinhead sized nodulesmonths. on the mucosal surface. The liver and spleen were enlarged and pale. Their consistency was On examination the patient was anaemic. firm and borders sharp.Physical examination of respiratory systemrevealed involvement of both lungs. The liver Microscopic examination revealed fibro-was enlarged, tender with a smooth surface. caseous pulmonary tuberculosis in both lungsOther systems revealed no abnormality. with tubercular bronchopneumonia. The trancheobronchial lymph nodes, small intestine Relevant investigations revealed: Hb 8.5 and spleen showed miliary tuberculosis. Ex-gm%; TLC 7000/cmm, DLC; P 48, L 50. E 2. tensive amyloid deposition was seen in theSputum was positive for A.F.B. Urine and liver, both adrenals and spleen, while thestool were normal, x-ray chest showed bilateral kidneys showed mild deposition of amyloidgeneralised infiltration with a doubtful cavity material. The aorta showed atheromatousin the right mid zone (Fig. 1). plaques. The patient was kept on antitubercular Discussiondrugs. His condition deteriorated on 11.1.70.His B.P. became low and despite revival In the present case of bilateral pulmonarymeasures he expired the same day at 7.20 tuberculosis in the associated diagnosis ofP.M. amyloidosis could be established only after autopsy. Cohen’s (1943) observed that 75% At autopsy the body was that of an young cases of amyloidosis have albuminuria or castInd. J. Tub., Vol. XIX, No. 3
  • 2. AMYLOIDOSIS IN TUBERCULOSIS 113and therefore, their presence in the urine loidosis either before or after chemotherapy.should make one suspect amyloidosis. Clinically Yoshizumi (1962) demonstrated a sharpin our case urine examination revealed no decline in incidence of amyloidosis with theabnormalities. Cango red test and gum biopsy advent of chemotherapy. It is not possible forwere also not done because of lack of clinical us to comment on incidence but the lowerdiagnosis of amyloidosis. Autopsy of the incidence of amyloidosis in our country aspatient on 12.1.71 confirmed the diagnosis of compared to western countries, may be due tobilateral pulmonary tuberculosis. The patient the lack of diagnosis. As in our case diagnosiswas also found to be suffering from generalised of amyloidosis could only be made aftermiliary tuberculosis and amyloidosis. Secondary autopsy which is a rare diagnostic procedureamyloidosis was seen in liver, spleen, kidney in our country.and adrenal, whereas, miliary tuberculosis wasobserved in intestine lymph node and spleen. SummaryAnderson (1957) reported that liver, kidney,spleen and adrenal are commonly involved in A case with fibrocaseous pulmonary tuber-secondary amyloidosis. Olekhnovich (1958) culosis with generalised secondary amyloidosisreported that in 42 cases of tuberculosis with of adrenal, liver, spleen and kidney and miliaryamyloidosis, kidney was involved 42 times, tuberculosis of spleen, intestines and glands,spleen 40 times and liver 30 times. In our is reported. Importance of autopsy in diagno-case spleen was the only organ which demons- sis of amyloidosis is emphasised.trated the presence of both amyloidosis andmiliary tuberculosis. Anderson (1957) reports REFERENCESthat the spleen is most commonly involvedorgan in amyloidosis as well as it is one of the 1. Anderson, W.A. (1957), Pathology, C.V. Mostry Co., St. Louis, p. 73.organs involved at the earliest stages. Miliaryinvolvement of intestine, lymph node, spleen 2 Chitkara, N.L., Chugh T.D., Chuttani, P.N.in our patient of fibrocaseous pulmonary tuber- and Chugh, K.S. (1965), Ind. J. Path. Bact. 8,culosis was possibly due to haematogenous 285-293.dissemination in preterminal stages of broncho-genie tuberculosis, as our patient died within 3. Cohen, S., (1943), Ann. Int. Med. 19, 990-1002.two weeks of admission in the hospital. Our 4. Kozello, N.A., (1963), Klin. Med. Mask. 41,case also demonstrates that tuberculous involve- 79-85.ment of an organ is not a pre-requisite foramyloidosis. Furthermore, amyloid deposites 5. Maltchik, F.A., (1959), Probl. Tuberk, 97, 37.in an organ do not favour development oftuberculosis because both amyloidosis and 6. Mathur, B.B.L. and Jhala, C.I. (1964), Ind. J.tuberculosis involved various organs in Path. Bact.l, 133-145.the present case. But both amyloidosis andtuberculosis simultaneously involved only 7. Reddy, C.R.R.M., and Parvathi, G. (1968),spleen. Maltchik (1959) observation that amy- Ind. Jour. Med.Sci. 22, 770-774.loidosis involves lesser number of organs whenit occurs in chronic forms of tuberculosis is 8. Reddy, C.R.R M., Sulochana, G., Rama Raocontradictory to our case finding as in the T., Devi, C.S., (1970), 17, 70-71.present case amyloidosis involved organs like 9. Olekhnovich, L.I. (1958), Probl. Tuberk. 96, 36.liver, spleen, adrenal and lungs. Yoshizumi(1962) reported that there is no difference in 10. Yoshizumi, M. and Lt, T.G. (1962), Amer, Rev,pathologic involvement of organs by amy- Resp. Dis. 85, 432-435, Ind. J. Tub., Vol. XIX, No. 3

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