- Miliary tuberculosis is a widespread spread of Mycobacterium tuberculosis via the bloodstream.
- Miliary TB very rarely occurs in an individual organ, affects several organs and the entire body including the brain in more than 90% of the cases.
- A characteristic feature of the infection is a large amount of TB bacilli. If left untreated it can be fatal [1].
A 56-year-old male patient was diagnosed with miliary tuberculosis after he presented to the emergency department with symptoms of fatigue, excessive weight loss, night sweats and fever. Additionally, the patient’s symptoms had appeared 2 months ago and during this tenure he had lost 10 kgs of weight. He also complained of an occasional blood-tinged cough.
The patient’s history highlighted that he had migrated to the United States from Haiti 10 years ago. Moreover, examination showed that the patient’s temperature was 36.2°C. In addition, although the patient was breathing comfortably, he appeared to be cachectic. Auscultation showed that the volume of airflow was equal in both lungs without crackles or wheeze.
For further evaluation, a dilated funduscopy was performed which showed polymorphic yellow lesions in the posterior poles of both eyes with indiscrete borders. Moreover, plain radiograph of the chest showed a distribution of nodules of uniform size evident in both lungs.
The diagnosis of miliary tuberculosis was made
Similarly, the ocular findings were consistent with the diagnosis of choroidal tubercles. The patient’s sputum sample was smear-positive for acid-fast bacilli.
The patient was prescribed combination therapy with rifampin, isoniazid, pyrazinamide, and ethambutol. A repeat sputum sample was tested after 1 week of therapy and was negative for acid-fast bacilli. After 6 weeks, the initial sputum sample was positive for pan-sensitive Mycobacterium tuberculosis.
The patient’s symptoms improved after initiation of treatment and continued the therapy for 6 months [2].
References
- Miliary Tuberculosis https://emedicine.medscape.com/article/221777-overview
2. Miliary Tuberculosis https://www.nejm.org/doi/full/10.1056/NEJMicm2001934
