Investigation of Nigerians with diffuse radiographic pulmonary shadowing

Abstract

During a five-year period, 45 Nigerians with radiographic appearances of diffuse pulmonary infiltration with at least six sputum specimens negative on culture for tubercule bacilli were investigated at University College Hospital, Ibadan. The value of pulmonary function studies and open or closed lung biopsy in discovering the cause of diffuse lung disease was examined. Cryptogenic fibrosing alveolitis was the most common cause (13 cases). Other diagnoses included malignant disease (11 cases), sarcoidosis (three cases), progressive systemic sclerosis (three cases), miliary and non-caseating tuberculosis (three cases) and pulmonary alveolar microlithiasis (one case): this last is believed to be the first case diagnosed in Africa South of the Sahara. This study emphasizes the fact that, even in developing countries where tuberculosis is highly prevalent, there are other causes of diffuse pulmonary infiltration.

Idiopathic pulmonary fibrosis misdiagnosed as sputum-negative pulmonary tuberculosis

“…[2] A case series in Nigeria revealed 28.9% of 45 patients with diffuse radiological pulmonary infiltrate had cryptogenic fibrosing alveolitis, some of which were mismanaged as tuberculosis. [3] There are also reported cases of IPF, some of which were initially managed as cases of smear-negative pulmonary tuberculosis. [24]…”

“…[1] However, IPF is a clinical entity that can mimic other causes of pulmonary fibrosis and undistinguishable on the historical basis alone. [23] This diagnostic dilemma played out in the index case when it was misdiagnosed and treated as a case of pulmonary tuberculosis.…”