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Miliary tuberculosis in an Indian lady: Looking beyond miliary tuberculosis.

Lakshman A, Dhir V, Kumar N, Singhal M - Lung India (2015 Sep-Oct)

Bottom Line: If sputum is negative for acid -fast bacillus, empirical anti-tubercular therapy is given without securing a histological or microbiological diagnosis.She was started on empirical anti-tubercular therapy.But an alternate diagnosis was achieved later with invasive sampling and ATT was stopped.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India.

ABSTRACT
Presence of miliary shadows in chest imaging in the appropriate clinical setting is often taken as a marker of miliary tuberculosis. If sputum is negative for acid -fast bacillus, empirical anti-tubercular therapy is given without securing a histological or microbiological diagnosis. We report a young female with human immunodeficiency virus infection who had miliary infiltrates on chest radiography. She was started on empirical anti-tubercular therapy. But an alternate diagnosis was achieved later with invasive sampling and ATT was stopped. This case illustrates the need for physicians to remain alert to diseases which mimic tuberculosis in presentation.

No MeSH data available.


Related in: MedlinePlus

Contrast-enhanced CT axial images at the level of renal hilum (a) And infra-renal levels. (b) Reveal discrete necrotic enlarged lymph nodes in aorto-caval, para-aortic locations and in the mesentery
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Figure 2: Contrast-enhanced CT axial images at the level of renal hilum (a) And infra-renal levels. (b) Reveal discrete necrotic enlarged lymph nodes in aorto-caval, para-aortic locations and in the mesentery

Mentions: A 23-year-old housewife, native of Bengal, presented to our hospital in north-west India with fever with chills and evening rise of temperature of three months, cough and breathlessness of three weeks and one episode hematemesis two days back followed by melaena. She had been recently detected to be human immunodeficiency virus (HIV) positive and her husband was also seropositive. Patient was tachypnoeic and tachycardic but, maintaining oxygen saturation on room air. She had pallor and palpable liver 2 cm under right costal margin. Her initial investigations showed anemia (4.5 g/dL), thrombocytopenia (105 × 103/µL), low white cell count (4200/µL), raised AST (120 U/L), ALP (412 U/L) and LDH (944 U/L) and low serum albumin (2.5 g/dL). Her CD4+ T-cell count was 23 cells/µL. There were miliary shadows in both lung fields on her chest X-ray which was confirmed on computed tomography (CT) scan of chest [Figure 1a and b]. Contrast CT of abdomen showed hepatomegaly and multiple enlarged retroperitoneal lymph nodes some of which were necrotic [Figure 2a and b]. A working diagnosis of disseminated tuberculosis was made and patient was started on anti-tubercular therapy (ATT).


Miliary tuberculosis in an Indian lady: Looking beyond miliary tuberculosis.

Lakshman A, Dhir V, Kumar N, Singhal M - Lung India (2015 Sep-Oct)

Contrast-enhanced CT axial images at the level of renal hilum (a) And infra-renal levels. (b) Reveal discrete necrotic enlarged lymph nodes in aorto-caval, para-aortic locations and in the mesentery
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4587007&req=5

Figure 2: Contrast-enhanced CT axial images at the level of renal hilum (a) And infra-renal levels. (b) Reveal discrete necrotic enlarged lymph nodes in aorto-caval, para-aortic locations and in the mesentery
Mentions: A 23-year-old housewife, native of Bengal, presented to our hospital in north-west India with fever with chills and evening rise of temperature of three months, cough and breathlessness of three weeks and one episode hematemesis two days back followed by melaena. She had been recently detected to be human immunodeficiency virus (HIV) positive and her husband was also seropositive. Patient was tachypnoeic and tachycardic but, maintaining oxygen saturation on room air. She had pallor and palpable liver 2 cm under right costal margin. Her initial investigations showed anemia (4.5 g/dL), thrombocytopenia (105 × 103/µL), low white cell count (4200/µL), raised AST (120 U/L), ALP (412 U/L) and LDH (944 U/L) and low serum albumin (2.5 g/dL). Her CD4+ T-cell count was 23 cells/µL. There were miliary shadows in both lung fields on her chest X-ray which was confirmed on computed tomography (CT) scan of chest [Figure 1a and b]. Contrast CT of abdomen showed hepatomegaly and multiple enlarged retroperitoneal lymph nodes some of which were necrotic [Figure 2a and b]. A working diagnosis of disseminated tuberculosis was made and patient was started on anti-tubercular therapy (ATT).

Bottom Line: If sputum is negative for acid -fast bacillus, empirical anti-tubercular therapy is given without securing a histological or microbiological diagnosis.She was started on empirical anti-tubercular therapy.But an alternate diagnosis was achieved later with invasive sampling and ATT was stopped.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India.

ABSTRACT
Presence of miliary shadows in chest imaging in the appropriate clinical setting is often taken as a marker of miliary tuberculosis. If sputum is negative for acid -fast bacillus, empirical anti-tubercular therapy is given without securing a histological or microbiological diagnosis. We report a young female with human immunodeficiency virus infection who had miliary infiltrates on chest radiography. She was started on empirical anti-tubercular therapy. But an alternate diagnosis was achieved later with invasive sampling and ATT was stopped. This case illustrates the need for physicians to remain alert to diseases which mimic tuberculosis in presentation.

No MeSH data available.


Related in: MedlinePlus