An unusual presentation of miliary tuberculosis

Abstract

A young Bangladeshi woman presented to the emergency department with vaginal discharge on a history of fevers and rigours. Although initially treated for pelvic inflammatory disease, the patient rapidly developed respiratory failure with acute respiratory distress syndrome. An axillary biopsy and a high-resolution CT of the chest confirmed miliary tuberculosis (TB). She was initiated on anti-TB medication and made a rapid recovery.

Figure 1

Arterial blood gas; significant hypoxia with poor alveolar-arterial gradient.

Figure 2

Admission chest X-ray.

Figure 3

Chest X-ray (day 2 of admission): bilateral pleural effusions with probable bibasal consolidation.

Figure 4

CT pulmonary angiography ground glass shadowing and bibasal pleural effusions.

Figure 5

High-resolution CT of the chest; multiple nodules in keeping with miliary tuberculosis.

Figure 6

High-resolution CT of the chest; significant axillary lymphadenopathy (see arrow).

Figure 7

Microbiology specimens; lymph node biopsy was able to confirm Mycobacterium tuberculosis.