Miliary tuberculosis with atypical presentation in an immunocompetent young African man

Disseminated mycobacterial septicemia presented as acute abdomen: a surgeon's perspective on Landouzy's sepsis

A 20-year-old man presented in emergency with fever, abdominal pain and obstipation. On evaluation, he was found to have an acute abdomen with septic shock. The cross-sectional abdominal imaging revealed hepatosplenomegaly, pleural effusion and ascites with retroperitoneal lymphadenopathy. He was resuscitated and started on broad-spectrum antibiotics. There was no other source of infection identified elsewhere. While bacterial and fungal cultures were negative, the sputum, blood, bone marrow and ascitic fluid were positive for Mycobacterium tuberculosis following which he was started on antituberculosis therapy. Despite therapy, the patient's clinical condition continued to deteriorate requiring critical care. In view of Landouzy's sepsis, pulse steroid therapy was started. However, the patient's clinical condition continued to deteriorate and developed systemic inflammatory response syndrome and multi-organ dysfunction syndrome. Despite the best efforts, the patient expired.