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Elevated concentrations of circulating ICAM-1 in far advanced and miliary tuberculosis.

Intercellular adhesion molecule-1 (ICAM-1) plays an important role in inflammatory diseases. Cellular expression and shedding of ICAM-1 are up-regulated by cytokines, such as tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma). With an ELISA containing two monoclonal antibodies to human ICAM-1, we measured concentrations of circulating ICAM-1 in patients with tuberculosis. Prominently elevated values were found in miliary tuberculosis and in far advanced pulmonary tuberculosis but not in minimal or moderately advanced disease. The measurement of serum IFN-gamma and TNF-alpha also revealed high concentrations of the cytokines in miliary tuberculosis and far advanced pulmonary tuberculosis. The circulating ICAM-1 values were significantly correlated to serum IFN-gamma and TNF-alpha values. In the case of miliary tuberculosis and far advanced pulmonary tuberculosis treated with antituberculous drugs, the circulating ICAM-1 concentrations were gradually decreased to correspond with improvement of clinical symptoms and chest X-ray findings. The measurement of circulating ICAM-1 is useful to evaluate the severity of tuberculosis and to monitor disease activity during antituberculous drug treatment.

Adult↗

[A case of miliary tuberculosis complicating acute Q fever].

A 73-year-old man was admitted with fever and abnormal liver function test. After admission, his fever persisted in spite of administrating a variety of antibiotics. He was diagnosed as acute Q fever on the basis of a high titer of IgM antibodies against phase II Coxiella burneti. His fever resolved after starting minocycline, but biliary enzymes continued to be elevated. Transbronchial lung biopsy and percutaneous liver biopsy revealed caseating granulomas and Mycobacterium tuberculosis was detected by culture. Miliary tuberculosis was diagnosed and his biliary enzymes declined after starting therapy with antituberculous drugs. This report of miliary tuberculosis complicating acute Q fever is a valuable and unprecedented case.

Acute Disease↗

An autopsy case of miliary tuberculosis and review of autopsy cases in Japan.

Presented is an autopsy case of a 79 year-old male who died of miliary tuberculosis. The patient was admitted to the University Hospital with an unknown fever and suspicion of leukemia. He expired on the 13th day of hospitalization. Postmortem examination revealed generalized miliary tuberculosis. The diagnosis of tuberculosis was established only after autopsy. Difficulty in diagnosis of miliary tuberculosis is discussed. Also discussed is a probable association of acute interstitial nephritis with chemotherapy or miliary tuberculosis. Leukemoid reaction is thought to be associated with miliary tuberculosis. The present case reminds us that miliary tuberculosis should never be forgotten when treating a patient having a fever of unknown origin. Cases with tuberculosis were compiled from the Annual of Pathological Autopsy Cases in Japan during 1974 through 1981. There were 3,242 cases of tuberculosis (1.4%) out of 235,095 autopsies recorded in the Annual of Pathological Autopsy Cases in Japan during the above 8 years. Of 3,242 cases 618 were miliary tuberculosis. The latter figure indicates 19.0% of all tuberculosis and 0.26% of all autopsies. Although all age groups were not spared, the 7th and 8th decades were more affected than the others. Tuberculosis has markedly declined since the advent of antituberculous antibiotics. But, autopsy cases with tuberculosis have not recently decreased in number. Clearly, increased awareness of the continuing presence of tuberculosis is needed.

Aged↗

Miliary tuberculosis and adult respiratory distress syndrome.

Three patients with miliary tuberculosis developed the adult respiratory distress syndrome. In two patients this complication developed despite treatment with antituberculous drugs. The third patient developed the syndrome, but miliary tuberculosis was not suspected. The presence of disseminated intravascular coagulation in all three cases suggests a possible pathophysiologic relation. Miliary tuberculosis should be considered in patients presenting with adult respiratory distress syndrome of unknown cause.

Adult↗