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PubMed1993

Extracorporeal shock wave lithotripsy complicated with miliary tuberculosis.

We report a case of miliary tuberculosis following extracorporeal shock wave lithotripsy (ESWL*). The patient had right lower caliceal and left distal ureteral calculi on excretory urography. He was hospitalized 50 days after ESWL with fever, weight loss and night sweats. Liver function tests were abnormal and he had hypoxemia. A chest x-ray at hospitalization was normal but a miliary pattern developed 10 days later. Diagnosis was tuberculosis based on culture of sputum in a Löwenstein medium. Liver biopsy confirmed caseating epithelioid granulomas. Antituberculous treatment was successful. We conclude that renal tuberculosis associated with calcification must be ruled out before treatment with ESWL to avoid a possible hematogenous dissemination.

Adult↗

PubMed1990

A case of miliary tuberculosis with disseminated choroidal haemorrhages.

A 20-year-old Japanese man had generalised miliary tuberculosis. Although he had no ocular symptoms, choroidal miliary tuberculosis with pleomorphic findings, including disseminated choroidal haemorrhages, was noted in both fundi. The haemorrhages disappeared as the patient's condition improved on medical therapy. Disseminated choroidal haemorrhages should be looked for in patients with miliary tuberculosis.

Adult↗

PubMed1988

Recurrent pneumothoraces in miliary tuberculosis.

An 18-year-old female patient with miliary tuberculosis presented with bilateral, simultaneous pneumothoraces, which were recurrent with a bronchopleural fistula. The recurrent pneumothoraces were managed with tube thoracostomy and pleurodesis. Various possible pathogenetic mechanisms of this rare complication are discussed.

Adolescent↗

PubMed1991

Miliary tuberculosis presenting as fever and jaundice with hepatic failure.

A 58-year-old male patient with miliary tuberculosis presenting as jaundice and hepatic dysfunction was reported. He was admitted to the Miyazaki Medical College Hospital, Miyazaki, Japan, because of fever and jaundice. Chest x-ray revealed a calcified primary affect of tuberculosis in the left upper lung field and miliary shadows throughout both lung fields. Liver function tests showed indications of obstructive jaundice and hepatic dysfunction. He rapidly deteriorated and died 3 days after admission. Autopsy revealed disseminated miliary tuberculosis in all major organs. Many miliary tubercles were densely distributed in the liver, especially in and near the portal tracts. The intestine was free from tuberculous lesions. Miliary tuberculosis with jaundice is rare and its pathogenesis is discussed.

Fever↗

PubMed1994

Re-evaluation of bone marrow aspiration in the diagnosis of miliary tuberculosis.

We studied eight patients with miliary tuberculosis (TB). In all instances, tuberculomatous lesions were demonstrated in the aspirated bone marrow. We conclude that the bone marrow aspiration has great value in diagnosing miliary TB because it provides sufficient material to permit examination of serial sections as needed to confirm the diagnosis. The bone marrow aspiration also is safer than the alternative procedures of lung or liver biopsies.

Adult↗

PubMed2002

[Thymoma complicated with miliary tuberculosis].

We report a case of thymoma complicated with miliary tuberculosis. A 69-year-old woman was admitted to a hospital because of body weight loss, general fatigue, and dyspnea. Chest X-ray showed a small, diffuse granular shadows in both lungs. Biopsied-specimens from bone marrow and left pharynx revealed granuloma with both giant cells and caseous necrosis. The diagnosis of miliary tuberculosis was made. The patient was then transferred to our hospital. Both chest X-ray and computed tomography conducted on admission revealed a mass in the mediastinum as well as diffuse granular shadows in both lungs. We suspected a presence of thymoma. Anti-tuberculosis therapy was started, and extended thymectomy was performed. The diagnosis of thymoma was confirmed pathologically. Immunological analysis of peripheral blood lymphocytes was done before and after the operation. Negative conversion of PPD reaction was observed after thymectomy. Although the response of peripheral lymphocytes to phytohaemoagglutinin (PHA) and concanavalin A recovered after thymectomy, a marked decrease of the number of CD 4 T cells, a decrease of T helper 1 cells, a slight increase in the number of B cells and cells expressing natural killer cell-related surface markers were observed throughout the course of illness.

Aged↗

PubMed1990

Ofloxacin in miliary tuberculosis.

We report one case of severe miliary tuberculosis with liver failure and respiratory insufficiency in a twenty-seven year old patient. We emphasize the presence of hepatic, occular and vestibular toxicities secondary to the treatment and the usefulness of ofloxacin with cycloserine given for nine months.

Adult↗

PubMed1989

[A case of miliary tuberculosis with intracranial tuberculoma].

A case of miliary tuberculosis with intracranial tuberculoma was reported. Homogenous or ring-like enhancing lesions surrounded with edema were seen after administration of contrast material on CT examination. However, CT is considered very useful method of evaluating the effect of antituberculous therapy.

Brain Diseases↗

PubMed1989

Fiberbronchoscopy in smear-negative miliary tuberculosis.

Twenty-two patients with smear-negative miliary tuberculosis underwent fiberbronchoscopy and brush smears; bronchial aspirates and transbronchial lung biopsy specimens were obtained. A definite diagnosis of tuberculosis was made in 16 (73 percent) patients. A rapid diagnosis was established in 14 of these 16 patients either from brush smears alone (three) or bronchial aspirate smear alone (one) or exclusively by histopathologic study of biopsy specimens (seven). Both brush smears and biopsy histopathology results provided the diagnosis in three patients. Bronchial aspirate culture was the only positive specimen in two patients. No serious complication resulted from the procedure. Our experience substantiates previous reports of the value and safety of fiberbronchoscopy in the rapid diagnosis of smear-negative miliary tuberculosis.

Biopsy↗

PubMed1994

[Asymptomatic multiple intracranial tuberculous nodules detected in a case of miliary tuberculosis].

A case of multiple intracranial tuberculous nodule following miliary tuberculosis was reported. The case was a 19-year-old woman visited a general practitioner, because of fever. Chest x-ray film on the first visit showed diffuse granular shadows in her both lungs with pleural effusion in the left side. The case was diagnosed as bacterial pneumonia, and was treated with antibiotics. She had been getting worse, and the doctor finally examined her sputum, and tubercle bacilli were seen in her sputum (Gaffky 4) by the Ziehl Neelsen's staining. She was introduced to our hospital. Chest x-ray film on admission showed diffuse granular shadows in her both lungs and she was diagnosed her as miliary tuberculosis, and anti-tuberculous therapy was quickly started. She didn't complain of any neurological disorders, but her brain CT showed several nodules in the left cerebral cortex enhanced with contrast medium. T1 weighted MRI enhanced by Gd-DTPA revealed abnormal enhancements in the cerebrum, the cerebellum, and the midbrain. She was treated with anti-epileptic drugs, but after 65 days, she started to suffer from epileptic stroke. Six months later, her brain lesions have improved by the use of anti-tuberculosis drugs and anti-epileptic drugs. The incidence of tuberculosis has decreased in Japan, and, many doctors did not show concern on, thus, a doctor's delay is a serious problem in Japan. Advocary should be made to doctors to detect tuberculous patients as early as possible.

Adult↗

PubMed1997

Miliary tuberculosis with unusual matted giant mesenteric lymph nodes.

We report a case of miliary tuberculosis in a 10-month old female with unusual matted giant mesenteric lymph nodes. She presented with prolonged fever and poor feeding for two months. With the evidence of miliary pattern in chest X-ray and the positive acid-fast bacilli from the sputum, she was treated with antituberculous chemotherapy. She died from pneumomediastinum and pneumopericardium. Post-mortem findings disclosed miliary tuberculosis involving major organs. Acid-fast bacilli were numerous. Large matted mesenteric lymph nodes measuring 10 x 6 x 5 cm3 were noted. A strikingly large palpable matted mesenteric lymph nodes in suspected miliary tuberculosis should not be confused with tumors in the children.

Female↗

PubMed2005

Tuberculous meningitis and miliary tuberculosis: the Rich focus revisited.

Tuberculous meningitis (TBM) develops most often when a caseating meningeal or sub-cortical focus, the Rich focus, discharges its contents into the subarachnoid space. It is recognized that TBM is frequently accompanied by miliary tuberculosis, but the relationship between the development of the Rich focus and miliary tuberculosis remains controversial. The original descriptions of Arnold Rich and Howard McCordock are reviewed together with the work of other pathologists and the observations of the natural history of tuberculosis by astute clinicians such as Arvid Wallgren and Edith Lincoln. Rich and McCordock dissociated miliary tuberculosis from a role in the pathogenesis of TBM, and this view continues to appear in reviews and textbooks dealing with TBM. We suggest, particularly in childhood, that miliary tuberculosis is indeed directly involved in the pathogenesis of TBM in as much as that the overwhelming bacillaemia that accompanies miliary tuberculosis serves to increase the likelihood that a meningeal or sub-cortical Rich focus will be established, which may in its turn caseate and give rise to TBM.

Animals↗

PubMed1998

[A case of miliary tuberculosis with multiple cerebral tuberculoma and spinal tuberculosis owing to total delay].

We reported a case of miliary tuberculosis with multiple cerebral tuberculoma and spinal tuberculosis. The case was a 37 year old man. In the last sixteen months to the first visit to a hospital, he has been suffering from low grade fever, cough, and back pain, but he bared his symptoms without any therapy. At a hospital he first visited, he was told that he might have a malignant disease, which prevented him to visit the hospital because of a fear for his disease. Six months later, he was admitted to other hospital because of severe back pain. At last, he was diagnosed as tuberculosis and referred to our hospital. By the examinations on admission he was diagnosed as multiple cerebral tuberculoma and spinal tuberculosis, and anti-tuberculous therapy was started. It is thought that his severe disease status on admission is caused by the total delay, namely the delay in visiting a doctor and the doctor's delay in making diagnosis.

Adult↗

PubMed2003

[A case of urinary and miliary tuberculosis detected during examination for renal failure].

A case of urinary and miliary tuberculosis in a 51-year-old male is reported. The patient with the complaint of low grade fever at night and appetite loss had visited another clinic. Laboratory data showed renal failure (serum creatinine 3.9 mg/dl, BUN 35.1 mg/dl) and he was referred to our hospital. Ultrasonography and computed tomography (CT) revealed bilateral hydronephrosis. Therefore we suspected postrenal renal failure. We performed cystoscopy in order to perform retrograde pyelography and to indwell double J stent. The bladder showed yellow-whitish nodules all over the bladder. Tuberculous bacilli were detected in the urine by smear, polymerase chain reaction (PCR) and culture. Chest radiography and CT revealed multiple granular nodules and so diagnosed miliary tuberculosis. Immediately combination chemotherapy of with isonicotinic acid hydrozide, rifapicin, ethanbutal and pirazinamide was administered. Histopathology by bladder biopsy showed epithelioid cell granuloma. Chemotherapy was effective, but the vesical capacity was contracted to less than 50 ml, and we suspect that the patient will need vesical augmentation.

Antitubercular Agents↗

PubMed2004

Cutaneous miliary tuberculosis in two patients with HIV infection.

Cutaneous manifestations of miliary tuberculosis are rare. We report two patients with previously unknown advanced human immunodeficiency virus (HIV) infection, who presented with respiratory collapse and an erythematous papulopustular skin eruption. Skin biopsies demonstrated focal dermal microabscess in one patient, and a subcorneal vesicle with an underlying dermal microabscess in the other. Despite the lack of granulomatous inflammation, acid-fast bacilli (AFB) and Fite stains demonstrated numerous acid-fast bacilli, and Mycobacterium tuberculosis was subsequently isolated in either skin and/or sputum cultures. Pulmonary involvement was present in both cases, but was sufficiently diffuse and atypical so as not to be specific for tuberculosis upon initial clinical and radiographic examination. Our two cases illustrate the importance of careful skin examination in patients with HIV infection, since cutaneous dissemination can be an easily overlooked sign of miliary tuberculosis.

AIDS-Related Opportunistic Infections↗

PubMed2003

Thrombocytopenic purpura associated with miliary tuberculosis.

The authors report a case of thrombocytopenia associated with miliary tuberculosis. The patient was a 28-year-old woman who was admitted because of massive upper gastrointestinal hemorrhage and acute respiratory failure. Chest radiographs revealed diffuse bilateral reticulonodular infiltration and complete blood count was significant for severe thrombocytopenia. Bone marrow biopsy was performed to investigate the cause of thrombocytopenia and demonstrated multiple tiny caseating granulomas suggesting miliary tuberculosis (TB). She received anti-TB therapy and a short course of steroid with good response. Platelet count returned to normal limit within 10 days. Although isolated thrombocytopenia is uncommon in TB, it is still important to consider TB in the differential diagnosis of thrombocytopenia, particularly in patients with abnormal chest radiographs. Bone marrow examination is very helpful in this situation.

Adult↗

PubMed1994

[A case of miliary tuberculosis with high-grade fever that remitted without antituberculosis therapy].

A 23-year-old man was admitted with a persistent high-grade fever of 20 days duration. Chest roentgenogram showed diffuse miliary shadows in both lung fields, highly suggestive of miliary tuberculosis. Sputum, gastric juice, and bronchoalveolar lavage fluid did not, however, reveal acid-fast bacilli on smears. A bone marrow aspirate and a transbronchial lung biopsy were also negative for caseating granulomas and tubercule bacilli. After admission, the high-grade fever remitted in several days without continuous antibiotic, antituberculosis or antipyretic therapy. Levels of inflammatory markers (CRP, ESR, alpha 2-globulin dropped simultaneously. Despite the atypical clinical course, miliary tuberculosis was suspected. We therefore carried out an open lung biopsy. The presence of caseating granulomas and acid-fast bacilli confirmed the diagnosis of miliary tuberculosis. The remission of miliary tuberculosis without treatment is very rare and the details of this case are presented herein with a discussion of the pertinent literature.

Adult↗

PubMedDate not supplied

High-resolution CT appearance of miliary tuberculosis.

OBJECTIVE: The purpose of this study was to define the range of abnormalities and to assess the contribution of high-resolution CT (HRCT) in the evaluation of miliary tuberculosis involving the lung parenchyma. MATERIALS AND METHODS: The authors retrospectively reviewed HRCT scans of 11 patients with microbiologically or clinically proved miliary tuberculosis. RESULTS: In 10 patients, the most characteristic HRCT finding of miliary tuberculosis was the presence of small nodules uniformly distributed throughout both lungs. The profusion of nodules was numerous in all 10 patients. High-resolution CT scans showed both sharply and poorly defined, small nodules varying in sizes from 1 to 2 mm (n = 6), 1 to 3 mm (n = 2), and 1 to 4 mm (n = 2) in diameter. These nodules had a diffuse random distribution in the secondary lobule in all 10 patients. In 1 of the 10 patients with small nodules on HRCT, chest radiography had shown no evidence of miliary nodules in the lung. In addition to nodules, HRCT showed diffuse or localized reticular opacities superimposed on nodules in five patients, especially in the lower lung zones. In 1 of all 11 patients, ground-glass attenuation was the predominant abnormality seen on HRCT. CONCLUSION: We believe that in the appropriate clinical situation, miliary tuberculosis may be suggested on HRCT. Moreover, in cases with no evidence of miliary nodules on the chest radiograph, HRCT scan may depict miliary nodules in the lung parenchyma.

Adolescent↗