Miliary tuberculosis

A 90-year-old man presented to the emergency department with a 2-week history of fever, intermittent cough and progressive dyspnoea. He had no previous medical history and was negative for human immunodeficiency virus infection. Chest radiography showed diffuse, bilateral, millet-seed sized lung nodules (Figure 1A). Thoracic high-resolution computed tomography revealed innumerable tiny micronodular lesions throughout the lung and peribronchovascular thickening in the perihilar regions (Figure 1B). Sputum and urine culture were positive forMycobacterium tuberculosis. Based on the clinical and radiographic findings, the patient was diagnosed as having miliary tuberculosis. Miliary tuberculosis refers to clinical condition resulting from haematogenous dissemination ofM.tuberculosis, and has become a rare disease in the developed countries, but is still common in areas where tuberculosis is endemic, especially in sub-Saharan Africa and in Southeast Asia.1 The signs and symptoms of military tuberculosis can vary depending on which organs are affected, including a cough, fever, weight loss, night sweats, pleurisy, haemoptysis and dyspnoea. These symptoms being non-specific are often missed. Sharmaet al.2 have reported that up to 50% of cases are not diagnosed antemortem. Tuberculosis is an old disease, but not a disease of the past. The emergence of multidrug resistant tuberculosis is a serious public health problem. Early identification of miliary tuberculosis can facilitate appro...
Source: QJM - Category: Internal Medicine Source Type: research