Unusual presentation of miliary tuberculosis in a 12-year-old girl: a case report.

BACKGROUND: Miliary tuberculosis (TB) is a lethal hematogenous spread form of mycobacterium tuberculosis with approximately 15-20% mortality rate in children. The present report highlights the clinical manifestations of an unusual presentation of miliary tuberculosis in a 12-year-old girl. CASE PRESENTATION: In this case, extensive lung involvement was presented despite the absence of respiratory symptoms. Also, some central hypo-intense with hyper-intense rim nodules were detected in the brain's pons, right cerebral peduncles and lentiform nucleus. CONCLUSION: The results of this study showed that severe miliary TB may occur even in a person who received the Bacille Calmette-Guérin (BCG) vaccine.

Disseminated tuberculosis in a migrant child.

Tuberculosis (TB) poses a major global health threat, substantially affecting children, who contribute notably to new cases and deaths. Diagnosing TB in kids is challenging due to collection issues and the paucibacillary nature of the disease. Disseminated TB, uncommon in children in low TB incidence countries, remains a significant cause of morbidity in migrant populations. We illustrate a rare case of disseminated TB in a middle-childhood boy who migrated from Angola to France, displaying chronic cough, fatigue, weight loss and persistent fever. Investigations revealed widespread TB affecting several organs (lungs, heart, bones and lymph nodes). Prompt diagnosis led to a treatment regimen of four antibiotics (isoniazid, rifampin, pyrazinamide, ethambutol) and corticosteroids, resulting in substantial improvement after 2 months. Subsequent treatment involved two antibiotics (isoniazid and rifampin) for 10 more months. This case underscores the criticality of early identification and comprehensive treatment for disseminated TB, ensuring improved outcomes and reduced risks.

Undiagnosed tuberculosis associated with hemophagocytic lymphohistiocytosis due to improper use of corticosteroid.

INTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening hematologic disease segregated into familial (primary) and acquired (secondary) subtypes. Hyperinflammation and HLH occur when the immune system fails to clear activated macrophages and histiocytes. Infections, malignancies, and rheumatologic disorders are the major triggers leading to HLH. Miliary tuberculosis is a serious disease with a lymphohematogenous spread of Mycobacterium tuberculosis, which is known to be one of the causative agents of HLH. Miliary tuberculosis and HLH have atypical presentations which are similar to routine diseases. Hence, physicians may face challenges to diagnose and treat these complications. CASE REPORT: We report the case of a 60-year-old man with a history of prolonged fever, shortness of breath, jaundice, altered mental status, undiagnosed lower back pain, and overuse of parenteral betamethasone. Miliary tuberculosis was diagnosed by diffuse, vague random micronodules in both lungs and positive acid-fast bacilli in bronchoalveolar lavage and bone marrow aspiration and biopsy. Moreover, compatible presentation and pancytopenia, hypertriglyceridemia, high serum level of ferritin and fibrinogen-derived products, and evidence of hemophagocytosis on bone marrow aspirate led to the diagnosis of HLH. Unfortunately, despite nearly two months of an anti-tuberculosis regimen (standard and salvage) and eight doses of etoposide, he eventually passed away after clinical improvement. CONCLUSIONS: Irrational and indiscriminate use of glucocorticoids can be a devastating cause of the spread of tuberculosis and its rare complications, such as HLH.

[Tuberculosis of the palatine tonsil mimicking a malignant lesion and associating pulmonary tuberculous miliaria: about a case in Ouagadougou, Burkina Faso]. / Tuberculose de l'amygdale palatine simulant une lésion maligne et associant une miliaire tuberculeuse pulmonaire : à propos d'un cas à Ouagadougou, Burkina Faso.

Tonsillar tuberculosis is the infectious localization of Koch's bacillus in the palatine tonsils. It is rare. Tonsillar tuberculosis associated with miliary tuberculosis is even more exceptional. Objective: The aim of our work is to report a rare case of tuberculous tonsillitis associated with miliary tuberculosis. Patient and methods: This was a case of tonsillar tuberculosis associated with miliary tuberculosis. The main complaint was chronic odynophagia, which had been present for 7 months and was associated with weight loss. Questioning also revealed alcohol, tobacco and marijuana consumption. Results: Oropharyngoscopy revealed an enlarged, ulcerated and hemorrhagic right tonsil, suggesting a malignant lesion. Diagnostic tonsillectomy with anatomopathological examination of the surgical specimen led to the diagnosis of tonsillar tuberculosis. A postoperative chest X-ray revealed tuberculous miliaria. No other tuberculosis site was identified. No other confirmatory biological tests were carried out. The patient was treated with 4 anti-tuberculosis drugs (rifampicin, isoniazid, pyrazinamide, ethambutol) during 2 months and 2 anti-tuberculosis drugs (Rifampicin, Isoniazid) during 4 months. The evolution was favorable and the patient was declared cured at the end of treatment. There was no recurrence after 5 years. Conclusion: Tonsillar tuberculosis is rare. Tonsillar tuberculosis associated with pulmonary miliaria is even more exceptional. Tonsil biopsy for anatomopathological examination is sufficient for diagnosis. A chest X-ray should be requested as part of the preoperative workup prior to any tonsillar biopsy or tonsillectomy. GeneXpert (MTB/RIF) should be carried out if possible, not only for its value in the biological confirmation of tuberculosis but also to identify rifampicin resistance. Antibacillary treatment often leads to a favorable outcome.

Disseminated tuberculosis: Clinical presentation, diagnosis, and outcomes in a tertiary-care hospital in Saudi Arabia.

Background: Tuberculosis (TB) is the primary infectious cause of mortality worldwide. Although TB incidence and prevalence are declining, the use of immunosuppressive drugs and the growing prevalence of immunocompromising conditions such as comorbidities, malignancies, and the use of immunosuppressive agents are risk factors for disseminated TB (DTB). This study aims to identify the relevant clinical, laboratory, radiological, and histopathological features of DTB, as well as to assess the typical anatomical distributions and treatment outcomes of patients diagnosed with the disease at King Abdulaziz Medical City (KAMC). Methods: A retrospective chart review was conducted, including all patients diagnosed with miliary or DTB at KAMC with retrievable medical files. Results: The study included 55 patients, of whom 35 (63.6%) were male and the median age was 64 years old. 35 (63.6%) of the infected patients were timely diagnosed and eventually cured from the illness. The most common comorbid conditions were diabetes, chronic kidney disease, and immunocompromising conditions, which were present in 37 (67.2%), 12 (21.8%), and 11 (20%) of the patients, respectively. The most common presenting symptoms were fever and cough, present in 31 (56.3%) and 26 (47.2%) of the patients, respectively, followed by weight loss in 25 (45.4%), night sweats in 15 (27.2%), and shortness of breath in 14 (25.4%). Approximately two-thirds of the patients had pulmonary miliary TB (MTB) (38; 69.1%), followed by TB lymphadenitis (21; 38.2%), central nervous system involvement (13; 23.6%), skeletal involvement (11; 20%), gastrointestinal involvement (5; 9.1%), pleural involvement (3; 5.5%), and urogenital TB (2; 3.6%). The mortality rate was 14 (25.5%) patients. Conclusion: MTB is challenging to diagnose due to nonspecific clinical, laboratory, and imaging findings. Clinicians dealing with patients who are at risk of developing DTB should be aware of the typical presentations and abnormal clinical findings. They should also have a low threshold to initiate specific investigations for the disease, as early diagnosis and effective treatment is critical in reducing morbidity and mortality rates.

Arteriovenous thrombosis in a patient with miliary tuberculosis complicated by a left ventricular mass and its treatment.

INTRODUCTION: Tuberculosis (TB) is considered one of the two greater long-term global public health threats than the coronavirus disease 2019 (COVID-19) pandemic. Although venous thromboembolism has a low prevalence of 3.5% among patients with active TB, miliary TB complicated by arteriovenous thrombosis is a rare and potentially life-threatening condition. CASE STUDY: We present here an unusual case of a 32-year-old man with a two-month history of shortness of breath and painful swelling in the right lower extremity. In addition, elevated plasma levels of platelets, white blood cells, neutrophils, and D-dimer were observed upon his admission to the hospital. The patient was diagnosed with miliary TB complicated by arteriovenous thrombosis in the right lower extremity and a left ventricular mass measuring 3.5 × 1.7 cm. He was successfully treated with anti-TB drugs and low molecular weight heparin followed by warfarin, aspirin and clopidogrel. CONCLUSIONS: This case study demonstrates that a patient with miliary TB complicated by arteriovenous thrombosis and a left ventricular mass can be cured with timely diagnosis and appropriate treatment. The implications of this report are to raise awareness about miliary TB and arteriovenous thrombosis, to improve diagnosis and treatment, and to reduce patient mortality through sharing our successful experience with clinicians and healthcare providers in the developing countries of the world.

Immune Reconstitution Inflammatory Syndrome and Drug-Induced Liver Injury During Treatment of Disseminated Tuberculosis in a Liver Transplant Recipient: A Case Report.

Studies have shown that tuberculosis (TB) incidence is 20 to 70 times higher in solid organ transplantation recipients. Immunosuppression makes transplant recipients more vulnerable to infection and can interfere with the treatment. Our case report describes a patient who experienced immune reconstitution inflammatory syndrome (IRIS) and drug-induced liver injury (DILI) related to TB medications for disseminated pulmonary and hepatic TB. In addition to anti-TB medication, the patient received a high-dose steroid for IRIS and a change of anti-TB medication to a secondary regimen for DILI. This case illustrates various responses to anti-TB treatment in a liver transplant recipient and the necessity of closely monitoring immune suppression and liver function.

Disseminated tuberculosis involving the eye, skin, axillary lymph nodes and lungs in an immunocompetent host.

A female in her early 40s presented to the outpatient clinic for weight loss, fatigue, cough, followed by a gradual painful loss of vision in the right eye associated with redness over the past 3 months. Physical examination revealed bilateral axillary lymphadenopathy and non-healing skin ulcers on the left forearm and the left gluteal region. The patient had no light perception in the right eye and grade 4+ cells in the anterior chamber. A chest X-ray showed a cavitary lesion in the left upper lobe. Histopathological tests from the skin and lymph nodes revealed caseating granulomas, raising the suspicion of tuberculosis. A sputum nucleic acid amplification test was performed, which returned positive for Mycobacterium tuberculosis The patient was treated with antitubercular chemotherapy and showed encouraging signs of progress after the treatment.

Need to reinvigorateTuberculosis research in India - A review of studies registered under clinical trial registry of India.

Tuberculosis (TB) is one of the most serious public health issues in India. According to the global TB report 2020, India accounts for about one-quarter of the global TB burden. Despite considerable advances in mandatory notification of all TB cases, incorporation of the national health programmes with general health services (National Health Mission), and national drug resistance surveillance and many other accomplishments, much more needs to be considered in India to significantly decrease TB incidence. Research is the foundation for medical breakthroughs. In this study, all Tuberculosis-related studies registered under Clinical Trial Registry of India from its inception in July 2007 to February 2021 were reviewed and analysed using the keyword ''Tuberculosis'' in the 'Trial Search' section. A total of 31,196 studies were registered in CTRI, with 180 studies (0.58%) being related to tuberculosis. Of these studies, 76 (42.2%) were interventional in nature. These consisted of evaluating different management or treatment TB (50%, n = 90), diagnostic studies (19.4%, n = 35) and studies related to screening and prevention of TB (7.8%, n = 14). Maximum studies were conducted to evaluate safety and efficacy of anti-TB drugs (10%, n = 18) and to evaluate efficacy of shortening of duration of treatment (8.9%, n = 16). The studies related to extra pulmonary TB, MDR TB and TB in special populations and sources of funding and locations of the study sites were also analysed. These indicate that only minimal TB-related researches are conducted in India. It is indispensable to promote tuberculosis research in India in order to eradicate this infectious disease.

Concurrent cerebral infarction and intracranial tuberculoma induced by the carotid plaque complicated with miliary tuberculosis.

Cerebrovascular complications of central nervous system tuberculosis (TB) are predictors of poor prognosis and adverse outcomes. These complications are mainly intracranial arterial involvement, with occasional venous involvement. Here, we present a 67-year-old woman with concurrent cerebral infarction and intracranial tuberculoma induced by the carotid plaque complicated by miliary tuberculosis. Mycobacterium tuberculosis was observed on the luminal side of the carotid plaques in pathological specimens. Treatment with anti-TB drugs alone would likely not cure the patient, as M. tuberculosis would continue to disseminate. Endarterectomy could directly remove the embolic source, and a complete cure was achieved.

Case Report: Tuberculosis-Induced Autoimmune Hemolytic Anemia.

Tuberculosis (TB) is an infectious disease that affects different organs, causing multiple complications, including hematological sequelae. One of the most common TB-hematological complications is anemia of chronic disease. Very rarely autoimmune hemolytic anemia (AIHA) has been reported as an uncommon manifestation of TB. In this case, we present a female who presented with refractory AIHA, which was attributed to disseminated TB. The patient responded well to steroids, anti-TB medications, and rituximab.

Miliary tuberculosis-associated hemophagocytic lymphohistiocytosis with a high level of soluble interleukin-2 receptor successfully treated with concomitant recombinant thrombomodulin: A case report.

Hemophagocytic lymphohistiocytosis (HLH) is a fatal disease characterized by a highly inflammatory state due to the abnormal activation of T lymphocytes and macrophages. Miliary tuberculosis (MTB) is a rare cause of HLH and its clinical appearances occasionally resembles that of intravascular lymphoma (IVL). A 76-year-old woman presented with persistent fever and fatigue. Abnormal laboratory findings showing thrombocytopenia (13,000/µL), hypofibrinogenemia (101 mg/dL), hyperferritinemia (2,312 ng/mL), and markedly elevated soluble interleukin-2 receptor (sIL-2R) level (32,200 U/mL), in addition, hemophagocytosis in the bone marrow (BM) smear, were suggestive of IVL-associated HLH. The pathology of the BM biopsy specimen showed granuloma with non-caseous necrosis, and culture tests using sputum, gastric fluid, urine, and peripheral and bone marrow blood revealed the presence of Mycobacterium tuberculosis, leading to the final diagnosis of MTB-associated HLH. Anti-TB medications and corticosteroids were administered, but thrombocytopenia, hypofibrinogenemia, and hyperferritinemia persisted. Concomitant use of recombinant thrombomodulin (rTM) enabled regression of clinical status. In this case, BM biopsy served as the diagnosis of MTB-associated HLH, although IVL-associated HLH is initially suspected by an extremely high level of sIL-2R. Furthermore, this case report informs that using rTM could improve the outcomes of MTB-associated HLH.

A rare case of miliary tuberculosis in a patient with NSCLC receiving PD1 inhibitor therapy, mimicking autoimmune pneumonitis.

ABSTRACT: Immune checkpoint inhibitors (ICIs) are widely used for the treatment of various types of cancer. One of the possible immune-related adverse effects of ICI is pneumonitis, which is a life-threatening condition that can present as a variety of radiographic patterns, so it can be difficult to differentiate from infectious cases of pneumonia based on radiological findings alone. We present a rare case of miliary tuberculosis (M. tuberculosis) in a patient receiving programmed death-1 (PD-1) inhibitor therapy mimicking autoimmune pneumonitis and possible pathophysiological mechanisms of this unexpected event. We presented a 52-year-old patient with stage IV non-small-cell lung carcinoma (NSCLC) who was admitted to the hospital with radiological and clinical signs of pneumonitis caused by immunotherapy-Pembrolizumab. During hospitalization, she was clinically, laboratory, and microbiologically processed and her diagnosis of M. tuberculosis was confirmed. Initial treatment started with corticosteroids as a pneumonitis treatment, and because there was no adequate response, and the diagnosis of tuberculosis was confirmed, treatment with a four-regimen antituberculotic drug started. On a control, CT scan regression in distribution and number of changes in lungs occurred. After a while, patient died due to hepatic failure. There are not many reported cases of pulmonary tuberculosis in patients receiving immunotherapy; to our knowledge, no cases of M. tuberculosis in a patient with lung cancer were described. Since there is a different approach to the treatment of tuberculosis and pneumonitis, we presented our dilemmas and literature review in this article. A multidisciplinary approach (oncologist, radiologist, microbiologist, etc.) is essential in a case like this.

Multifocal cutaneous tuberculosis coexisting with pulmonary tuberculosis.

Tuberculosis (TB) is caused by Mycobacterium tuberculosis and it can affect multiple organ systems. Cutaneous TB, a less common type of extrapulmonary TB can coexist with TB of other organs. Here, we describe a case of multifocal cutaneous TB suggestive of two different morphological types with concomitant miliary pulmonary TB.

Does miliary sarcoidosis really exist? A case report and review of the literature.

BACKGROUND: Miliary sarcoidosis is a rare form of sarcoidosis characterized by numerous miliary-like micronodules dispersed throughout the lungs. It has been documented in less than 1% of all sarcoidosis cases. We first described a rare case of miliary sarcoidosis and then conducted a literature review on the subject. CASE PRESENTATION: A 51-year-old male complained about a progressive loss of appetite, significant weight loss, occasional night sweats, and fatigue. After a thorough clinical exploration, a differential diagnosis of miliary lung disease was suspected - miliary tuberculosis, fungal infection, metastatic pulmonary carcinoma, or sarcoidosis. High-resolution chest computed tomography revealed bilateral diffuse micronodules with mediastinal lymphadenopathy. Histopathological analysis of transbronchial bioptic tissue identified non-caseating epithelioid granulomas, while no malignant cells were found. Lung tuberculosis and fungal infections were excluded. The levels of angiotensin-converting enzyme in the blood, as well as serum's and 24-hour urine calcium levels, were elevated. After a multidisciplinary discussion, the diagnosis of miliary pulmonary sarcoidosis was established. The patient was treated with prednisone for a total of 9 months, with full clinical and radiological recovery. Using PubMed, we also conducted a review of the literature on this topic and discovered only a few case reports of patients with miliary sarcoidosis, with just one systematic review accessible. The key findings of studies investigating patients diagnosed with miliary sarcoidosis are tabularly displayed. CONCLUSIONS: Miliary sarcoidosis is an uncommon type of pulmonary sarcoidosis that can mimic several entities that manifest as miliary nodules. Most patients require treatment since it can have a significant impact on lung function.