Micro and Pathology-IT based integrated learningMicro and Pathology-IT based integrated learning contributor /course creator: Dr Imam Shaik, Prof Wong Eng Hwa, AP Dr Priya Madhavan, Dr Farzana Rizwan. Learning Outcome LO 1: Discuss tuberculosis in terms of aetiopathogenesis, morphologic features, including use of special stains, organs involved, radiologic features, clinical presentation, and prognosis. LO 2: Describe the transmission and pathogen’s virulence factor.

Case history A 21-year-old Indonesian maid complaining of cough with yellowish, blood-tinged sputum since three months. She has evening rise of temperature and night sweats. She has noticed a loss of appetite and around 5kg weight loss during the last one month.

On examination the patient was thin and malnourished. On inspection a single diffuse swelling with ill-defined borders of approximately 4 × 3 cm in the left submandibular region. On palpation mass was firm in consistency, tender, mobile, and showed signs of matting (also non fluctuant & non compressible).   On chest auscultation, crepitations are heard in the right upper zone.

The consultant started anti-tubercular treatment. Unfortunately, patient had multi-drug resistance tuberculosis, and later developed miliary tuberculosis This is the chest X-Ray findings in this patient after developing miliary tuberculosis.

She died of multi-system organ failure. An autopsy was performed. The following are the picture and photomicrograph of her lungs removed at autopsy.