Limits...
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

Bone marrow trephine biopsy at high power (×40) showing cellular bone marrow with increase in histiocytes
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4587007&req=5

Figure 3: Bone marrow trephine biopsy at high power (×40) showing cellular bone marrow with increase in histiocytes

Mentions: Cytopenias were suspected to be due to bone marrow involvement by TB. However, bone marrow trephine biopsy showed presence of histiocytes laden with histoplasma [Figures 3 and 4a and b] Patient was started on intravenous amphotericin deoxycholate at 1 mg/kg/day and ATT was stopped after 6 days. Patient became afebrile on fourth day of starting amphotericin and cytopenias started improving. During hospital stay, patient had one episode of hemetemesis and an episode of hematochezia. Tc99m-RBC scan was done which showed evidence of active gastrointestinal bleeding involving distal jejunum/proximal ileum. Patient was managed conservatively and PRBC transfusions were given. Amphotericin infusion was continued and patient improved. A bronchoalveolar lavage and guided fine needle aspiration from retroperitoneal lymph nodes were planned to exclude co-infection with tuberculosis. But, patient and relatives were not willing for further evaluation and she was discharged on oral itraconazole after starting highly active anti-retroviral therapy (HAART). On follow-up at 6 months patient had improved. Her chest X-ray was normal and her cytopenias had resolved.


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

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

Bone marrow trephine biopsy at high power (×40) showing cellular bone marrow with increase in histiocytes
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Bone marrow trephine biopsy at high power (×40) showing cellular bone marrow with increase in histiocytes
Mentions: Cytopenias were suspected to be due to bone marrow involvement by TB. However, bone marrow trephine biopsy showed presence of histiocytes laden with histoplasma [Figures 3 and 4a and b] Patient was started on intravenous amphotericin deoxycholate at 1 mg/kg/day and ATT was stopped after 6 days. Patient became afebrile on fourth day of starting amphotericin and cytopenias started improving. During hospital stay, patient had one episode of hemetemesis and an episode of hematochezia. Tc99m-RBC scan was done which showed evidence of active gastrointestinal bleeding involving distal jejunum/proximal ileum. Patient was managed conservatively and PRBC transfusions were given. Amphotericin infusion was continued and patient improved. A bronchoalveolar lavage and guided fine needle aspiration from retroperitoneal lymph nodes were planned to exclude co-infection with tuberculosis. But, patient and relatives were not willing for further evaluation and she was discharged on oral itraconazole after starting highly active anti-retroviral therapy (HAART). On follow-up at 6 months patient had improved. Her chest X-ray was normal and her cytopenias had resolved.

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