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At least 973 records · Page 54Linked to original sources
PubMed1998

[Cerebral and pulmonary miliary tuberculosis in an immunocompetent patient: aggravation in an adequately treated patient].

BACKGROUND: Extrapulmonary localizations are observed in 20% of tuberculosis cases, mainly in immunosuppressed patients. Prognosis is poor in case of relatively uncommon cerebral localizations and miliary dissemination, especially if treatment is initiated in late stages. We report a case of disseminated tuberculosis associated with cerebral and pulmonary localizations in an immunocompetent patient. THe disease progressed despite adapted treatment. CASE REPORT: A young immunocompetent man with an uneventful history developed miliary tuberculosis with pulmonary localizations visualized on the computed tomography (CT) of the thorax. Brain CT was normal, but magnetic resonance imaging revealed several intracranial lesions. The disease course was marked by development of neurological symptoms and progression of the cerebral lesions after one month of treatment. No evidence of therapeutic failure (insufficient dosing, non-compliance, primary resistance) could be identified. DISCUSSION: Magnetic resonance imaging provides a more precise evaluation of tuberculosis lesions in the brain. Early antituberculosis therapy associated with corticosteroids can improve prognosis. Clinicians should be aware that cerebral lesions may continue to progress despite appropriate treatment, a course which is not satisfactorily explained by any current pathogenic hypothesis.

Adult↗
PubMedDate not supplied

Fulminant miliary tuberculosis with adult respiratory distress syndrome undiagnosed until autopsy: a report of 2 cases and review of the literature.

Despite an overall decline in the incidence of tuberculosis (TB), the percentage of cases representing miliary TB has remained stable. We report 2 cases of fatal miliary TB that remained unrecognized until autopsy, occurring within a 6-month period at 1 Detroit institution. These cases represent the wide range of presentation of miliary TB, from an acute fulminant course to a cryptic prolonged course with subtle clinical findings. Both cases shared a common end point with the development of adult respiratory distress syndrome.

Autopsy↗
PubMed1990

[Miliary tuberculosis in adults. Study of 67 patients].

67 patients with miliary TB diagnosed over a 15 year period (1973-1987) have been retrospectively studied. The clinical and analysis data were evaluated, highlighting different factors associated to higher mortality. 53 patients diagnoses were made premortem and 14 had the diagnosis made post-mortem. The age of the patients was of 48 +/- 21 (mean +/- DE) years, inferior to other series, this showing a higher prevalence and early age of infection in the area. 63% had miliary radiological features; the most frequent tests performed were liver biopsy with profitability of 80% and bronchoscopy which, together with transbronchial biopsy and bacterial analysis of the bronchoalveolar lavage, showed a positive diagnosis of 60%. The factors which were associated with bad prognosis were cavitated or chronic lesions (P less than 0.01), chronic diseases and immunosuppression factors associated, this not being statistically significant.

Adolescent↗
PubMed2004

Multidrug resistant miliary tuberculosis and Pott's disease in an immunocompetent patient.

In a high tuberculosis TB prevalence country, mortality due to miliary TB is not unknown but the treatment outcome in general is good. We describe a previously healthy man with miliary TB who did not respond to 2-months antituberculous therapy with 4 drugs. Persistent complaints of backache, which antedated chest symptoms, resulted in a diagnosis of Pott's disease. Culture of bronchial aspirate yielded multidrug resistant Mycobacterium tuberculosis that responded slowly to streptomycin, ethionamide, cycloserine, clofazimine, ofloxacin, paraaminosalicylic acid and isoniazid. The association of multidrug resistant miliary TB with Pott's disease in an immunocompetent patient is yet to be highlighted.

Drug Therapy, Combination↗
PubMed1978

[Acute, lethal miliary tuberculosis due to Mycobacterium bovis].

The authors report a case of lethal acute miliary with bovine tuberculous bacilli. They stress the main characteristics of this exceptional observation :--difficulties in isolating and identifying,--favourable disposition linked to age and to a depressed cellular immunity,--pathogenic interest in the mechanisms of late endogenous reinfestation and of suffocating acute evolution.

Acute Disease↗
PubMed1990

Tuberculous thyroiditis and miliary tuberculosis manifested postpartum in a patient with thyroid carcinoma.

Right nodular goiter with diffuse miliary shadow on chest roentgenogram was found in a postpartum febrile woman. Transbronchial lung biopsy revealed tuberculous granuloma and acid-fast bacilli were found by aspiration cytology of the thyroid. Although chemotherapy was effective, the thyroid nodule remained palpable and the serum thyroglobulin level remained high. Subtotal thyroidectomy revealed papillary carcinoma associated with tuberculosis and lymph nodes metastasis. This seems to be the first case report of a patient with tuberculous thyroiditis, coexisting with thyroid carcinoma, diagnosed by aspiration cytology and treated prior to surgery.

Adult↗
PubMed1990

[A case of spontaneous regression of malignant lymphoma, complicated with miliary tuberculosis, liver dysfunction and pancytopenia].

An 82-year-old woman was admitted to Iwamizawa Rosai Hospital, Cardiovascular Medicine, for detailed examination of an aneurysm of abdominal aorta. CT scan revealed marked swelling of para-aortic lymph nodes which regressed spontaneously in three months. She was re-admitted to our hospital because of general malaise and gait disturbance. Her chest X-ray on the second admission revealed miliary disseminated shadows, which were confirmed to be tuberculous granuloma by lung biopsy. She was initially well controlled with anti-tuberculosis drugs, followed by severe liver dysfunction and pancytopenia, and died of respiratory and cardiac failure. At autopsy, wide-spread malignant lymphoma and miliary tuberculosis of the lung were found. The cause of liver dysfunction was strongly suspected to be due to infiltration of the lymphoma cells to portal triads of the liver. Hemophagocytosis found in the bone marrow, spleen and liver might be consistent with clinically so-called "hemophagocytic syndrome", causing pancytopenia, associated with infection.

Aged↗
PubMed1990

Occult fatal pulmonary embolism with disseminated intravascular coagulation. An unusual case masquerading as miliary tuberculosis.

We report a fatal case of occult pulmonary embolism complicating bronchogenic carcinoma which presented with rapidly progressive pulmonary miliary shadows and respiratory failure. A clotting profile abnormality compatible with disseminated intravascular coagulation was noted. Postmortem examination showed extensive clots occluding the major pulmonary vessels and areas of pulmonary infarcts. Histologic examination revealed fibrin deposition in the microvasculature compatible with DIC. Cases of pulmonary embolism with DIC have previously been reported, but this is the first case with pathologic confirmation. Thus, unusual presentation with diffuse lung shadow and DIC should not deter the clinician from correct diagnosis so that appropriate treatment can be promptly started.

Adult↗
PubMed2005

Miliary tuberculosis involving the central nervous system.

A woman with chronic systemic lupus erythematosus (SLE) was treated with prednisone, and developed an acute febrile neuroinfection. The magnetic resonance images (MRI) showed miliary micronodular lesions distributed diffusely within the central nervous system and lungs. Lumbar puncture showed pleocytosis with predominance of polymorphonuclear leukocytes, hypoglycorrhachia, elevated proteins and smears positive for acid-fast bacilli. The diagnosis was confirmed by culture of Mycobacterium tuberculosis in the cerebrospinal fluid and bronchial biopsy tissue. She was treated with ethambutol, rifampin, isoniazid and pyrazinamide. MRI taken one month later showed significant improvement, but leg weakness persisted. Epidemiologic research showed her uncle with cavitary tuberculosis as the source of infection. He was also treated with combined antituberculous chemotherapy.

Adult↗