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PubMed1986

Acute miliary tuberculosis in a child with anhidrotic ectodermal dysplasia.

A 20-month-old boy with anhidrotic ectodermal dysplasia developed fever and papulopustular skin lesions. A skin biopsy showed the histologic changes of acute miliary tuberculosis. Anhidrotic ectodermal dysplasia is characterized by an absence of seromucous glands in the oropharynx and tracheobronchial tree, making children with this disease prone to viral and bacterial respiratory infections. Mild defects in their immunologic system have also been reported. We suggest that these abnormalities may have predisposed the patient to this rare form of cutaneous tuberculosis.

Ectodermal Dysplasia↗
PubMed1994

[A case report of miliary tuberculosis with acute respiratory failure diagnosed by polymerase chain reaction method].

A 51-year-old male was admitted because of cough and high fever. His chest X-ray and CT revealed miliary shadows, he was administered some antibiotics. But on the 8th day, his chest X-ray revealed ground glass shadows and he was under severe hypoxemia. We suspected miliary tuberculosis with acute respiratory failure due to his clinical course. The intensive therapy with antituberculosis drugs, hydrocortisone (1 g/day) was started and intubation was performed. The smear of the clinical samples did not show acid-fast bacilli on admission. However, by the polymerase chain reaction amplification method specific DNA fragments of Mycobacterium tuberculosis complex were detected from BALF and bone marrow. He was extubated after the 13th day and he recovered. It is difficult to separate and identify tubercle bacilli rapidly, but PCR is available for early diagnosis.

Acute Disease↗
PubMed1995

Clinical profile, laboratory characteristics and outcome in miliary tuberculosis.

We report a retrospective series of 100 non-HIV adult patients with miliary tuberculosis (MTB) treated in a tertiary care centre. There were 51 males. Their mean age was 35 years. Predisposing conditions existed in 34. Twelve patients had larger-than-miliary (> 2 mm) shadows in their chest roentgenograms. Five presented with acute respiratory failure, and early treatment cured four of them. Hyponatraemia occurred in 42/60 patients (70%) for whom values were available. Twelve patients (12%) died of MTB. Temperature > or = 39.3 degrees C (p < 0.01), hypoalbuminaemia (p < 0.01), hyponatraemia (p < 0.001), history of vomiting (p < 0.001) and presence of crepitations on auscultation (p < 0.001) were independent predictors of mortality. Diagnosis of MTB is difficult even in an endemic area, as the clinical symptoms are non-specific and the chest roentgenograms do not always reveal classical miliary changes. A high index of clinical suspicion and diligent efforts in confirming the diagnosis are needed, as early therapy yields good results.

Adolescent↗
PubMed2004

Acute renal failure on immune reconstitution in an HIV-positive patient with miliary tuberculosis.

Immune reconstitution syndrome following HAART in human immunodeficiency virus (HIV)-infected patients is characterized by inflammatory worsening of organ functions despite improvement in HIV surrogate markers of HIV infection. We describe a patient with miliary tuberculosis and urinary shedding of acid fast bacilli who developed acute renal failure 8 weeks after initiation of antituberculosis therapy and 6 weeks after initiation of HAART. The diagnostic workup and further course of disease implicated immune reconstitution syndrome as the cause of acute renal failure.

Acute Kidney Injury↗
PubMed1990

[A case of miliary tuberculosis with prolonged high fever for more than 2 months under antituberculous therapy].

A 28 year-old male was admitted to our hospital with persistent cough and high fever. He was diagnosed to have miliary tuberculosis by the transbronchial lung biopsy specimen and tuberculous choroidal lesions in the ocular fundus. Antituberculosis therapy was immediately started. In spite of the fact that the bacilli were sensitive to the antituberculosis drugs used and he had no other complications, high fever persisted and lasted for more than 2 months. When tuberculosis is suspected, and antituberculosis treatment is tried to observe its clinical response, the presence of similar cases mentioned above should be taken into consideration.

Adult↗
PubMed1998

Miliary tuberculosis presenting as tenosynovitis in a case of rheumatoid arthritis.

A 77-year-old woman with a seropositive nodular rheumatoid arthritis and vasculitis, who was treated with high doses of corticosteroids and intravenous cyclophosphamide, developed miliary tuberculosis that was heralded by a tenosynovitis in her right wrist. A 1-year course of anti-tuberculous therapy resulted in complete resolution of the tenosynovitis and disseminated infection.

Aged↗
PubMed1998

Massive posterior fossa tuberculous abscess developing in a young child treated for miliary tuberculosis. Possible role of very rapid acetylation of isoniazid.

A 21-month-old infant presented with acute obstructive hydrocephalus due to a large tuberculous abscess in the posterior fossa 3 months after starting treatment for miliary tuberculosis. Insertion of a ventriculo-peritoneal shunt resulted in some clinical improvement but subsequent neurological deterioration occurred due to massive enlargement of the tuberculous abscess despite apparently adequate antituberculosis therapy. Repeated drainage procedures of the abscess eventually resulted in resolution and clinical improvement. As part of the workup for poor weight gain and the unusual clinical course, the patient's acetylation status for isoniazid was determined and found to be very rapid. Doubling the daily dose of isoniazid was followed by a dramatic weight increase and further clinical improvement. Decreasing the load of tuberculous antigen by draining the abscesses and increasing the pulse exposure of isoniazid is the best possible explanation for the clinical improvement finally seen in this patient.

Abscess↗
PubMed1995

[Miliary tuberculosis. Autopsy study of 29 cases].

A retrospective anatomoclinic study of 29 cases of miliary tuberculosis, selected from 2.808 necropsies carried out at Hospital Central de Asturias between 1971 and 1994, is described. Fifty eight per cent of the patients were older than 50 years. Predisposing factors were identified in 80%: diabetes, alcoholism, chronic hepatopaty, silicosis, chronic renal failure, immunessupresive treatment and malignant neoplasms. A premorten correct clinical diagnosis were done in 8 cases (27.5%) and were suspected in 4 (13.7%). Typical miliary radiologic pattern was established in 17%. The more frequently affected organs were lungs (100%), liver (82%), spleen (75%), lymphatic nodes (55%) and bone marrow (41%). Early diagnosis and treatment is nowadays more difficult because of increasing of cryptic tuberculosis, involvement of resistant organs (pancreas), new predisposing factors (chronic renal failure), new risk groups (AIDS) and lack of demonstrative clinical and radiologic findings, so is necessary to maintain suspect of this disease always in mind.

Adolescent↗
PubMed1989

Branhamella catarrhalis as a cause of pneumonia in a patient with miliary tuberculosis.

Branhamella catarrhalis is increasingly reported as a cause of pneumonia in the immunocompromised host. The authors here report what they believe to be a unique case of B catarrhalis bronchopneumonia in a patient who had previously acquired miliary tuberculosis. The patient initially responded to medication but died suddenly following a brief episode of febrile illness. At autopsy, several lines of evidence implicated B catarrhalis in the findings. The authors review the literature regarding cases of lower respiratory tract infection reportedly caused by B catarrhalis. Their own conclusion is that B catarrhalis infection is not necessarily caused by abnormal immunoglobulin, as some workers have suggested, but rather by damaged lung tissue in general and damaged bronchoalveolar cells in particular.

Aged↗
PubMed1994

Severe hypercalcaemia associated with miliary tuberculosis.

Hypercalcaemia is uncommon among patients with pulmonary tuberculosis in Hong Kong, possibly because of the low dietary calcium intake in this population. We report here a case of severe hypercalcaemia in a patient with miliary tuberculosis and impaired renal function. We suggest that tuberculosis should be excluded in any febrile patient with hypercalcaemia, particularly in countries where it is still a common condition and an important cause of hypercalcaemia.

Adult↗
PubMed1992

Acute miliary tuberculosis of the skin in acquired immunodeficiency syndrome.

In human immunodeficiency virus-infected persons the clinical and radiographic appearance of pulmonary tuberculosis is frequently atypical, and extrapulmonary involvement is more frequent. We describe what we believe is the first case of a human immunodeficiency virus-infected person with acute miliary tuberculosis of the skin.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Miliary tuberculosis associated with multiple intracranial tuberculomas.

In this study we have reported a 12-year old girl patient who visited out-patient clinic with the history of headache and convulsion. The patient was diagnosed as miliary tuberculosis and multiple brain tuberculomas. Miliary infiltration was observed in chest x-ray and high-resolution thorax computed tomography (CT), and multiple tuberculomas surrounded with wide edema was observed in Magnetic Resonance Imaging (MRI). Acid-fast bacilli were detected in inducted sputum and gastric fluid. Focal epileptiform activity was seen in electroencephalography (EEG). The patient was administered antitubercular, anti-edema and antiepileptic therapy. The patient had not experienced convulsion for the second time and EEG had been normal; therefore her treatment was completed within 12 months. Chest x-ray and high-resolution thorax CT findings turned to normal and brain MRI findings improved significantly. As a conclusion, tuberculosis disease has very different clinical pattern depending on the organs it involves. The significance of our case is due to the presence of both the miliary tuberculosis and intracranial tuberculomas. The patient was admitted to the hospital due to central nervous system symtoms rather than pulmonary symptoms.

Brain↗
PubMed1977

Radiologic features of miliary tuberculosis in children and adults.

We reviewed the radiologic features of 19 children and 26 adults with miliary tuberculosis. Children had a very high prevalence of associated lymph node enlargement compared to the adults (95% vs. 12%). Pulmonary consolidation was more common in children (42% vs. 12%). Pleural effusions were uncommon in both groups. The miliary pulmonary lesions cleared faster in children. Evidence of previous tuberculosis was seen in 31% of the adults but none of the children. Most of these differences in radiologic features between children and adults probably represent differences in pathogenesis for hematogenous spread in the two groups.

Adolescent↗
PubMed2006

Effect of antituberculosis treatment on cardiopulmonary responses to exercise in miliary tuberculosis.

BACKGROUND & OBJECTIVES: Tuberculosis (TB) is a major health problem in the developing world. In this preliminary study, we report the effect of antituberculosis treatment (ATT) on cardiopulmonary responses to exercise in patients with miliary tuberculosis (MTB). METHODS: The prospective study of cardiopulmonary responses to exercise in patients with MTB within one month of starting (n=14), on completion of ATT (n=7) and in 15 healthy subjects using the incremental exercise test was performed on a bicycle ergometer. RESULTS: In MTB patients, mean body mass index (BMI), exercise duration (3.1 vs 4.6 min), work load (63 vs 91.4 watts), resting tachycardia, tachypnoea and the mean oxygen saturation improved significantly (P<0.05) with ATT. Mean oxygen consumption (V . O(2)) at anaerobic threshold (546.7 vs 580.9 ml/min) and maximum exercise (1008.1 vs 1022 ml/min) were similar before and after ATT. In MTB patients, post-treatment mean body weight, BMI, resting heart rate, respiratory rate and oxygen saturation during maximum exercise were similar, but exercise duration (4.6 vs 6.2 min, P<0.05), work load (91.4 vs 145.5 watts, P<0.05), V . O(2) and oxygen pulse were significantly lower as compared to healthy subjects. INTERPRETATION & CONCLUSION: In MTB patients, though there was significant improvement in clinical parameters, functional abnormalities persisted on exercise testing after completion of ATT. As most patients with MTB are young and economically active, these observations obviously have long-term implications for these individuals.

Adult↗
PubMed2006

[Transient worsening of chest radiograph and development of lymphadenopathy during chemotherapy for miliary tuberculosis].

A-37-year old woman was referred to our hospital because of bilateral pulmonary micronodular shadows on chest X-ray. Prednisolone was reported to be administered for her coughs and dyspnea more than a month, but was discontinued recently. Under the diagnosis as miliary tuberculosis, we started to treat her with the combined use of pyrazinamide, isoniazid, rifampicin, and ethambutol. Then her symptoms subsided gradually. Two months later, however, high fever developed, followed by exacerbation of the radiographic shadows, and marked cervical and mediastinal lymphadenopathy. We considered them so-called paradoxical worsening, and continued the antituberculosis therapy unchanged. Those clinical manifestations began to subside about 4 months after the initiation of the treatment. Paradoxical worsening has been described as a relatively rare manifestation, and seem to be attributable to prompt recovery of the immunity to mycobacterial antigens after the use of antituberculous therapy. We considered that, in this case, disseminated tuberculosis and firstly administered steroid that might suppress immune function, and discontinuation of steroid therapy followed by the bactericidal antituberculous chemotherapy were associated with the development of the paradoxical reactions, by analogy with immune reconstitution syndrome frequently reported in HIV-related tuberculosis patients.

Adult↗
PubMed1992

[Miliary tuberculosis as a complication of BCG immunotherapy in cancer of the bladder. Case report].

Intravesical administration of BCG may be used as an ancillary immunotherapy after endoscopic resection for cancer of the bladder. Local side effects are usually mild. Here is reported a patient who developed miliary tuberculosis after this form of therapy. Radiologic studies of the thorax and liver biopsy confirmed the diagnosis. The patient recovered after treatment with anti-tuberculosis drugs (TA-81 scheme). Epithelial trauma may be invoked as an alteration facilitating this complication. Although it develops infrequently, patients with bladder cancer treated with BCG must be monitored for this complication.

BCG Vaccine↗
PubMed1996

[Subacute effusive-constrictive pericarditis accompanied with miliary tuberculosis: a case report].

With the advent and the introduction of effective antimicrobial therapy, the mortality for tuberculosis pericarditis decreased in number dramatically. The problems, however, remains in several severe cases. We have experienced a rare case of 74 year old male with subacute effusive-constrictive pericarditis accompanied with miliary tuberculosis. The patient revealed improvement immediately after early an emergent pericardiectomy. However cardiac failure recurred thereafter because of fibrous epicarditis of tuberculous inflammation. Management of subacute effusive-constrictive pericarditis as this has many problems including surgical intervention such as operative timing and indication and/or role of corticosteroids together with antituberculotic drugs.

Aged↗