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Currently, miliary TB has a higher incidence among the elderly and immunodepressed patients, and exceptionally in young adults. A case of miliary tuberculosis was diagnosed in a young immunocompetent patient without using invasive techniques. The clinical and diagnostic implications will be discussed.
A 74-year-old housewife was admitted to the hospital with complaints of high fever and general fatigue. The physical examinations on admission showed no particular findings except for mild hepatomegaly, but laboratory findings showed severe liver dysfunction, active inflammation and negative tuberculine test. On the 4th day, she suddenly complained of severe respiratory distress. A chest X-ray film demonstrated surprising changes in comparison with that taken on admission. On suspicion of adult respiratory distress syndrome (ARDS) associated with military tuberculosis (Miliary TB), administration of Methylpredonisolone (1000 mg a day for 3 days) in addition to antituberculous drugs was immediately started. With this therapy she was recovered from such ill condition, but the general exhaustion and slight fever continued. We suspected that her condition might be due to adrenocortical involvement of Miliary TB and hormonal examinations were performed. Unexpectedly, Cushing's syndrome was suspected on the basis of the following; high level of plasma cortisol without normal daily variation, normal ACTH level, an absent response to the Dexamethasone suppression test. Computed tomography revealed left side adrenal mass. During these examinations, renal dysfunction probably due to Miliary TB grew gradually worse and she died of renal failure on the 56th day. Necropsy revealed disseminated tuberculosis involving the lungs and the liver, but the adrenal glands were not examined.
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Miliary tuberculosis is caused by the hematogenous spread of Mycobacterium tuberculosis and consists of 1.5% of all tuberculosis cases. It is seen mostly in infants because of the immature immune system, and central nervous system CNS involvement is not rare. Tuberculomas are rarely seen in the localized form of CNS tuberculosis, and only 4% are localized in the brain stem. We report a 4.5-month-old infant who deteriorated during follow-up with the diagnosis of cytomegalovirus pneumonia, and afterwards received the diagnosis of miliary tuberculosis. Although the baby had no neurologic abnormality and cerebrospinal fluid findings were normal, cranial MRI revealed contrast enhanced nodular lesions in pons, cerebellum, and right parietal region. The case is presented to intensify the importance of CNS investigation even if the patient with miliary tuberculosis has no neurologic finding.
Miliary tuberculosis is an unusual cause of acute, catastrophic pulmonary failure. In this report, we describe three patients with miliary tuberculosis who developed the adult respiratory distress syndrome. The diagnosis of tuberculosis was suspected early, appropriate therapy was initiated, and two patients survived. The experience with these cases serves to reemphasize the importance of maintaining a high index of suspicion for treatable precipitating disorders in patients with acute respiratory failure.
Miliary tuberculosis presenting as fatal adult respiratory distress syndrome is reported in a 69-year-old man. Idiopathic thrombocytopenic purpura led to splenectomy 2 years before admission and was currently treated with corticosteroids. Moderate dyspnea, a dry cough and weight loss were presenting clinical features, preceding respiratory failure by only a few days. In these patients with atypical symptoms early diagnosis and prompt antituberculous chemotherapy are life-saving. The diagnosis of miliary tuberculosis should be systematically considered in ARDS of unknown origin.
Miliary infiltrates observed on chest films in non-Hodgkin's lymphoma are extremely rare. We report a case with pulmonary infiltrates mimicking miliary tuberculosis associated with prominent eosinophilia and elevated IgE levels. The levels of circulating eosinophils correlated with disease activity as they transiently returned to normal after effective chemotherapy in a short period. However, the patient developed acute respiratory failure due to the rapid progression of the disease even with intensive chemotherapy. We emphasize that small nodular shadows appear to be a sign of the rapid progression of the disease and a poor prognosis.
Although the incidence of pulmonary tuberculosis had been rapidly decreased in Japan, it is pointed out that the rate of decrease in annual incidence became smaller in recent years. This slowing down of the rate of decrease is considered to be resulted from an increase in number of individuals who are more susceptible to tuberculous infection; such as the elderly, young people who are not exposed to TB bacilli previously and therefore not immunized, patients with malignant disease or with organ transplantation and HIV-infected persons. Pulmonary tuberculosis still remained as a pulmonary infectious disease of highly ranked importance. Especially, miliary tuberculosis is life-threatening and occasionally fatal unless early intensive antituberculosis chemotherapy was started on the basis of a rapid and definite diagnosis. We made a retrospective survey to clarify the characteristic clinical features of miliary tuberculosis. For this purpose, we compared the characteristics and clinical features of 10 patients with miliary tuberculosis and those of 18 patients with severe pulmonary tuberculosis, not due to hematogenous dissemination. The mean ages of miliary tuberculosis group and that of severe pulmonary tuberculosis group were 62.6 and 63.8 years old, respectively, with no significant difference. Nine out of ten patients with miliary tuberculosis had fever as one of initial symptoms, whereas, all the patients with severe pulmonary tuberculosis had cough and sputa but they seldom developed fever (high fever) at the initial stage of their diseases. Duration from onset of symptom to the admission was 1.2 months on average in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
The development of severe adverse reactions to antituberculous drugs in a patient with miliary tuberculosis led to unorthodox, suboptimal antituberculous therapy. The patient's failure to respond to therapy was discovered when acid-fast bacilli were detected in new skin lesions. Such lesions have been described in the literature as tuberculosis cutis miliaris disseminata; 24 cases (in addition to that described herein) have been reported thus far. The patient eventually recovered completely after detection and drainage of a large retrofascial tuberculous abscess. This case illustrates the importance of careful examination of the skin in clinical medicine, as tuberculosis cutis miliaris disseminata is an easily overlooked sign of miliary tuberculosis.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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