A 28-year-old male patient, recently diagnosed with HIV infection and miliary tuberculosis
(TB) based on characteristic chest CT findings and positive sputum culture, presented to the emergency department with new onset of ataxia (Figure 1A).
We believe that miliary tuberculosis
resulting in adrenal insufficiency (or Addison's disease) may have resulted in the oral and physical symptoms witnessed by the Inuit.
In this case, disseminated infection including miliary tuberculosis
and fungal infection, drug-induced interstitial pneumonia, intravenous talc granulomatosis, extrinsic allergic alveolitis, and pneumoconiosis needed to be differentiated; however, a definite diagnosis was made by the histological finding of non-necrotizing epithelioid granuloma with multinucleated giant cells (Figure 1b).
Challenges in the diagnosis and treatment of miliary tuberculosis
Histiocytic hemophagocytosis in miliary tuberculosis
There are four major categories of cutaneous tuberculosis: (1) inoculation from an exogenous source (primary inoculation tuberculosis, tuberculosis verrucosa cutis); (2) endogenous cutaneous spread contiguously or by auto-inoculation (scrofuloderma, tuberculosis cutis oroficialis); (3) hematogenous spread to the skin (lupus vulgaris, acute miliary tuberculosis
, and tuberculosis ulcer, gumma, or abscess); (4) tuberculids (erythema induratum [Bazin's disease], papulonecrotic tuberculids, and lichen scrofulosorum).
accounts for 2% of all forms of active tuberculosis.
Josephine was allegedly buried in a pauper's plot in the cemetery in 1902, after she succumbed, according to her death certificate, to miliary tuberculosis
and ulceration of the breast.
Ayrancioglu, "A case of tuberculous meningitis with multiple intracranial tuberculomas and miliary tuberculosis
and choroid tubercles," Infection, vol.
Recurrent bilateral pneumothorax complicating miliary tuberculosis
with bone marrow involvement.
Diffuse hepatic involvement with pulmonary or miliary tuberculosis
, diffuse hepatic infiltration without recognizable pulmonary involvement is the second form and the third very rare form presents as a focal/local tuberculoma or abscess.
Fatal miliary tuberculosis
in an HIV-infected Cameroon woman: disseminated histoplasmosis due to Histoplasma capsulatum capsulatum [in French].