Miliary Tuberculosis in a Healthy Adult

Abstract

Miliary tuberculosis (TB) is a consequence of mycobacterial dissemination. In theearly stages it can be a challenging diagnosis due to the systemic but non-specificsymptoms and subtle and gradual imaging changes. The dissemination of wall componentsof Mycobacterium tuberculosis can induce a severe inflammatory response withgeneralized endothelial cell damage, leading to fatal complications, such as disseminatedintravascular coagulation (DIC) and acute respiratory distress syndrome (ARDS).We report a 34-year-old woman with no known medical disorders. She was diagnosedwith miliary TB at the late stage of infection which presented with a fulminant clinicalcourse, including DIC and multi-organ failure. The autopsy revealed multiple foci ofinfection in the kidneys, spleen, meninges, lungs, and vertebral bodies. Disseminationof TB to extrapulmonary organs is a diagnostic challenge when the onset precedes pulmonarysymptoms, thereby eluding clinical suspicion and a rapid diagnosis. The durationfrom the onset of symptoms and laboratory abnormalities can be key predictors forthe development of late stage complications. The poor prognosis of military TB canbe mitigated by the early detection and rapid initiation of appropriate antituberculousmedications.