Miliary tuberculosis with pulmonary and extrapulmonary component complicated with acute respiratory distress syndrome

Abstract

Miliary tuberculosis results from the lymphohematogenous spread of the tubercle bacilli to the vascular beds in the lungs and other organs. Diagnosis is made by clinical judgment and chest X-ray showing miliary mottling of the lung fields. Another imaging study like computed tomography imaging of the lungs and abdomen can also be supportive in diagnosing miliary tuberculosis. We present a case of miliary tuberculosis in an immunocompetent young male with atypical manifestation of a left-sided pleural effusion and a life-threatening complication of acute respiratory distress syndrome during hospital stay which required noninvasive mechanical ventilation and steroids therapy, along with antitubercular medication.

A case of disseminated tuberculosis mimicking metastatic cancer

“…Ultrasound can facilitate the diagnosis and show testicular hypoechoic nodules [ 4 ]. Pleural and bone involvement are more common manifestations of EP-TB [ 7 , 8 ]. However multifocal skeletal TB is rare and can be difficult to differentiate from bony metastasis on CT and MRI [ 9 ].…”

All Signs Point to Cancer: A Case of Cryptic Miliary Tuberculosis in the Setting of Concomitant Cancer

“…Diagnosis may be masked by more classic pathologies such as chronic obstructive pulmonary disease (COPD) exacerbation and pulmonary thromboembolism [ 5 ]. Rarely, miliary TB can become fulminant leading to acute respiratory distress syndrome (ARDS), septic shock, multiorgan failure, and death [ 8 , 9 ].…”

“…Active TB infection is typically treated with rifamycin, isoniazid, pyrazinamide, and ethambutol for 2 months followed by rifamycin and isoniazid for 4 months, for a total of 6 months of treatment. Most patients with miliary TB receive this empiric treatment and some have shown further improvement with the use of steroids [ 3 , 9 , 11 ]. However, there is no current consensus regarding the optimum duration of treatment for disseminated TB or the use of steroids in treatment [ 2 ].…”

Tuberculose miliar em paciente imunocompetente – Relato de caso/Miliary tuberculosis in an immunocompetent patient - Case report

“…A Tuberculose miliar é uma doença caracterizada pela disseminação linfo-hematogênica do Mycobacterium tuberculosis, que acomete tanto pulmão quanto os demais órgãos, possuindo esse nome devido à presença de granulomas com formato de milho amplamente distribuídos pelo organismo do paciente. [1,2,3,4,6]. Acredita-se que essa forma de disseminação seja resultado de uma inadequação da resposta das células "T efetoras" e de uma reativação concomitante de focos de M. tuberculosis em vários órgãos e sistemas.…”

“…Há também o envolvimento cutâneo por meio de máculas e pápulas eritematosas (tuberculose miliar cutis), e o envolvimento neurológico representado pela meningite por TB e mielopatia transversa torácica. [1,2,3,4,6,9,10] Outras manifestações presentes na TB miliar são pericardite, miocardite com chance de evoluir para morte súbita, endocardite infecciosa, insuficiência cardíaca, insuficiência renal e glomerulonefrite, insuficiência adrenal, icterícia e ascite. Além disso, apesar de a TB miliar se manifestar como a principal forma de TB extrapulmonar, ela também tem um acometimento pulmonar, marcado pela presença de hipoxemia, hipercapnia, pneumotórax e complicações, tais como pneumomediastino e evolução para síndrome do desconforto respiratório agudo.…”