Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2025 Jan 7;17(1):e77098.
doi: 10.7759/cureus.77098. eCollection 2025 Jan.

Delayed Pulmonary Manifestations of Miliary Tuberculosis Following a Normal Initial High-Resolution Computed Tomography

Yasushi Murakami  1 , Shun Shibata  2 , Mika Morosawa  1 , Yasuhiro Nozaki  1 , Yoshio Takesue  3
Affiliations
Case Reports

Delayed Pulmonary Manifestations of Miliary Tuberculosis Following a Normal Initial High-Resolution Computed Tomography

Yasushi Murakami et al. Cureus. .

Abstract

Miliary tuberculosis (TB) is a potentially fatal form of TB resulting from the widespread dissemination of Mycobacterium tuberculosis. Although the presence of pulmonary miliary infiltrates usually facilitates diagnosis, atypical cases lacking these characteristic imaging findings frequently confound clinicians. Here, we describe the case of an 82-year-oldJapanese woman with miliary TB who initially presented with fever but showed no abnormalities on high-resolution computed tomography (HRCT) and microbiological tests; hence, fever of unknown origin was diagnosed. The delayed appearance of miliary infiltrates on repeated HRCT and positive interferon-gamma release assay (IGRA) led to a definitive diagnosis through bone marrow aspiration, bronchoalveolar lavage, and blood cultures. This case highlights the importance of miliary TB as a differential diagnosis for persistent fever, although initial imaging studies showed no abnormalities. Additionally, we discuss the value of repeated HRCT, IGRA, and minimally invasive diagnostic procedures for the early detection and timely treatment of miliary TB.

Keywords: blood culture; bone marrow aspiration; fever of unknown origin; high-resolution computed tomography; miliary tuberculosis.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. CT findings during hospitalization.
(A, B) Non-contrast CT on day 0 (admission) and contrast-enhanced CT on day 13, respectively. (A) There were no abnormal findings in the lung parenchyma except passive atelectasis in the dependent areas. No hepatomegaly or splenomegaly is observed. A round lesion adjacent to the spleen is identified as a left-sided renal cyst (arrow). (B) Widespread, poorly defined small nodules and ground-glass opacities are observed diffusely in both lungs. The liver and spleen exhibited no morphological abnormalities or enlargements. A left renal cyst is observed (arrow). CT: computed tomography
Figure 2
Figure 2. Pathological findings of bone marrow aspirate.
(A) Granuloma formation with Langhans giant cells is observed (arrow). The bone marrow shows normal trilineage hematopoiesis. (B) Acid-fast bacilli are identified within the granuloma. Staining: (A) hematoxylin and eosin staining and (B) Ziehl-Neelsen staining. Scale bar: (A) 100 μm and (B) 50 μm.
See this image and copyright information in PMC

References

    1. Miliary tuberculosis: new insights into an old disease. Sharma SK, Mohan A, Sharma A, Mitra DK. Lancet Infect Dis. 2005;5:415–430. - PubMed
    1. Review of literature on disseminated tuberculosis with emphasis on the focused diagnostic workup. Khan FY. J Family Community Med. 2019;26:83–91. - PMC - PubMed
    1. High-resolution CT appearance of miliary tuberculosis. Oh YW, Kim YH, Lee NJ, Kim JH, Chung KB, Suh WH, Yoo SW. J Comput Assist Tomogr. 1994;18:862–866. - PubMed
    1. Clinical and radiologic characteristics of radiologically missed miliary tuberculosis. Choe J, Jung KH, Park JH, Kim SH, Kim MY. Medicine (Baltimore) 2021;100:0. - PMC - PubMed
    1. Fever of unknown origin. Haidar G, Singh N. N Engl J Med. 2022;386:463–477. - PubMed

Publication types

LinkOut - more resources