Unsuspected miliary tuberculosis.
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Tuberculosis is a disease that should never be underestimated. It can affect anybody at any age. Doctors in the West do not have much experience of peritonitis secondary to tuberculosis. It is a condition that requires urgent and aggressive management as it can be fatal, even in the young and fit, as this case report illustrates.
The peripheral blood of a 3 month old boy with disseminated tuberculosis showed CD30 positive monocytes on flow cytometric analysis. His liver contained CD30 positive staining macrophages and giant cells. CD30 is an activation antigen which has not been previously found on peripheral blood monocytes.
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The authors have followed the evolution of disseminated choroidal tuberculosis during a period of 16 months. At the beginning of the disease, fluorescein angiography showed an early 'screen effect' and later a 'focus effect'. During the later stage of the disease, the pigmented epithelium was seen to be involved as well, as demonstrated by (1) the presence of advanced pigmented chorioretinitis at the sites where the tubercles were observed at the beginning of the disease and (2) the presence of fluorescent areas early during fluorescein angiography.
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