BackgroundHemophagocytic lymphohistiocytosis is a frequently fatal and likely underdiagnosed disease. It is a rare occurrence in adults and usually secondary to an insult such as viral infections, bacterial infections, autoimmune connective tissue disorders, malignancies and immunocompromised states, in contrast to its childhood counterpart, which is due to a genetic defect but may share some of same genetic etiologies. It is characterized by multisystem inflammation due to unregulated proliferation and infiltration of macrophages and CD8 T cells in the bone marrow, which leads to phagocytosis of red blood cells, platelets, lymphocytes and their precursors.Case presentationA 40-year-old Sri Lankan woman presented with a high-grade fever of 2 weeks’ duration and the initial workup, including a thorough clinical examination, and all the investigations, including a septic screen, were normal. On the 18th day of hospital admission, she was found to have yellowish retinal lesions, which were confirmed as choroid tubercles by the consultant eye surgeon. Two days later she became pancytopenic and a bone marrow biopsy confirmed the diagnosis of hemophagocytic lymphohistiocytosis. She was treated with conventional category-1 antituberculous drugs and an initial 2 weeks with high-dose oral dexamethasone. All the choroid tubercles gradually disappeared and she recovered completely without any complications.ConclusionsIn an adult patient with hemophagocytic lymphohistiocytosis, it is pivotal to understand the underlying etiology, as it needs extensive immunosuppression. If this patient had been treated with immunosuppressants without antituberculous medications, it would have been lethal with disseminated or central nervous system tuberculosis. So, in areas where tuberculosis is endemic, if no underlying cause is found, it may be worth considering antituberculous treatment for these patients. Re-evaluation with thorough clinical examination is of utmost importance in any patient with pyrexia of unknown origin as well as in any disease with unusual manifestations.

Objectives The silica industry is rapidly expanding in Sri Lanka. The main objective of this study was to assess the prevalence of silicosis among workers exposed to silica dust, and to describe the disease pattern of the affected. We also screened the affected workers for tuberculosis.

BackgroundLung cancer is a leading cause of cancer-related mortality in Sri Lanka and throughout the world. The latest staging system for lung cancer is the tumor node metastasis (TNM) 7th edition in which there are major changes to the previous version. The objective of our study was to find out the implications of TNM7th edition on lung cancer staging in a resource limited setting, and to compare it with the previous TNM 6th edition.MethodsPatients with histologically proven lung cancer consecutively presented to respiratory unit of Teaching Hospital Kandy, Sri Lanka were recruited to the study over a period of one year from April 2010 to March 2011. They were staged using CT, ultrasound scan of abdomen, bronchoscopy and CT spine and brain when necessary. Staging was done using TNM 7 as well as TNM6. Surgical or non-surgical treatment arms were decided on staging and the number of patients in each treatment arm was compared between the two staging systems.ResultsOut of 62 patients, thirty four patients (54%) had metastatic disease and 19 (30%) of them had pleural effusions (M1a), while 15 (24%) had distant metastasis (M1b). When compared to TNM6 there was no difference in the number of patients in T1 category, but the number in T2 was higher in TNM7 (25 Vs 20). Similarly the number in T3 group was higher in TNM7 (11 Vs 5) and the number in M category was doubled (34 Vs 17 [Chi-6.46, p = 0.011]) compared to TNM 6. The number of patients suitable for surgery were 17(27.5%) in TNM 7 and 18(29%) [Chi-0.02, p = 0.88] in TNM6.ConclusionsThis study shows that a significant proportion of patients were having advanced disease with distant metastasis on presentation. The number of patients falling to stage IV is significantly higher when staged with TNM7 but there was no significant difference in the number of patients undergoing surgery when TNM 7 was used compared to TNM6.

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Introduction: Anti-tuberculosis drugs can cause adverse reactions including hepatitis and skin reactions. This case control study was aimed at fi nding out whether allergy to drug or food acts as a risk factor for the development of anti-tuberculosis drug induced hepatitis or skin reactions. Patients with tuberculosis on category 1 regimen, who presented to the Teaching Hospital Kandy Sri Lanka, due to anti-tuberculosis drug induced hepatitis or skin reactions from 1st July 2010 to 30th June 2011 were recruited. Methodology: Patients with drug induced hepatitis or skin reactions were grouped as cases and patients who didn’t develop hepatitis or skin reactions during the treatment period were selected as controls. Controls were matched for age, gender, weight, and consumption of alcohol. Cases and controls were inquired for the presence of allergy to drugs or food. Two groups were compared using odds ratio. Results: There were 61 cases [33 (54.1%) males, 28 (45.9%) females] and 61 controls .Ten patients (16.39%) among the cases had allergy to food or drugs while in control group only 2 (03.2%) had allergy. Odds ratio for the development of drug reactions in patients with a history of allergy was 5.8 (confi dence interval 1.2 to 27.6). Conclusion: Patients with allergy to drugs or foods have 5.8 times risk of developing anti-tuberculosis drug induced hepatitis or skin reaction. SAARC Journal of Tuberculosis, Lung Diseases & HIV/AIDS; 2013; X(2); 48-53 DOI: http://dx.doi.org/10.3126/saarctb.v10i2.9714