Miliary tuberculosis in an immune‐competent Bangladeshi man—A case report

Abstract

Miliary tuberculosis (MTB) is a rare and fatal infectious disease that occurs due to the lympho-hematogenous spread of Mycobacterium tuberculosis bacilli. 1 According to the world health organization (WHO) 2021 reports, the incidence of tuberculosis in Bangladesh and Malaysia is around 221 and 97 per 100,000 people, respectively. It involves commonly the lung but may also affect other systems in the body. In all forms of tuberculosis cases, MTB occurs in 1%-2%, and in extrapulmonary tuberculosis, it is approximately 8%. 2 Clinical features of MTB are nonspecific, such as prolonged pyrexia, night sweats, weight loss, lassitude, anorexia, hepatomegaly, and abdominal pain. When the lungs are, an affected patient presents with cough, dyspnea, and chest pain. Occasionally, patients with miliary tuberculosis can present with "pyrexia of unknown origin" (PUO).Atypical clinical manifestation often delays the diagnosis and may cause a fatal outcome. Therefore, a high index of clinical suspicion is needed to diagnosing of MTB. Chest radiography plays a vital role in the initial detection and final diagnosis of MTB, but miliary mottling is seen in only 50% of cases of miliary tuberculosis. 3 Only one-third of MTB patients are sputum smear-positive. Histological demonstration of granulomatous inflammation in biopsy tissue (e.g., liver, lung, and bone marrow) is usually required to make a prompt diagnosis. 4 The molecular diagnosis of mycobacterium tuberculosis DNA by polymerase chain reaction is helpful, and it is rapid, sensitive, and specific. 5 MTB is more likely to see in an immune-compromised patient due to suppression of their cellular immunity and is rarely affected in an immune-competent patient.Herein, we reported a case of miliary tuberculosis in an immune-competent Bangladeshi man presented with pyrexia of unknown origin and hyponatremia.