Images in Clinical Medicine
Miliary Tuberculosis
N Engl J Med 2010; 363:1059September 9, 2010
- Article
A 20-year-old man who was negative for infection with the human immunodeficiency virus was admitted to the hospital with a 20-day history of fever (temperature of 103.6°F [39.8°C]). Chest radiography performed 9 days before presentation was reported to be normal, and broad-spectrum antibiotics were administered for 8 days as empirical treatment for the fever, without improvement. On admission, the patient reported having shortness of breath. A physical examination was notable for mild tachypnea and tachycardia. Repeat chest radiography revealed diffuse, bilateral, small lung nodules (Panel A). High-resolution computed tomography of the chest (Panel B) showed innumerable tiny, well-defined, miliary nodules throughout the lungs, pleural surfaces, and bronchovascular structures. The nodules were randomly distributed and ranged in diameter from 1 to 3 mm. Sputum cultures grew Mycobacterium tuberculosis. The patient was treated for acute miliary pulmonary tuberculosis with ethambutol, rifampin, pyrazinamide, and isoniazid. The fever resolved after 3 weeks, and the patient completed 1 year of antituberculosis therapy without incident.
Xiang-Dong Mu, M.D.
Guang-Fa Wang, M.D.
Peking University First Hospital, Beijing, China
muxiangdong@medmail.com. cn
