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PubMed1992

[A follow-up study by MRI and enhanced-MRI in a case of cerebral tuberculosis].

We report a case of cerebral tuberculosis following miliary tuberculosis. A 54-year-old man was admitted to our hospital in October 1990 because of fever and general fatigue. Chest x-ray film on admission showed diffuse granular shadows in both lungs. Tubercle bacilli were seen in the sputum (Gaffky 5) by the Ziehl Neelsen's staining, and anti-tuberculous therapy was quickly started. But a few days after admission, the disturbance of consciousness, neck stiffness, and headache appeared. The examination of cerebrospinal fluid disclosed that leucocytes was increased in number, and that ADA was elevated to 14.6 IU/l. Tubercle bacilli were detected from cerebrospinal fluid by culture. Although CT scan of the brain was normal at first week of admission, brain CT at eighth week of admission showed several nodulus enhanced with contrast medium. The findings were confirmed by T2 weighted magnetic resonance images (MRI) as high intense areas. Although T1 weighted MRI showed isointensity of the gray matter, T1 weighted MRI enhanced by Gd-DTPA revealed abnormal enhancement. At twenty-ninth week of admission CT showed no abnormality even by contrast enhancement, but enhanced T1 weighted MRI revealed a small lesion with enhancement which was not shown by CT. MRI enhanced by Gd-DTPA was more useful for evaluating cerebral tuberculosis than brain CT.

Brain Diseases↗
PubMed1997

[Bouchut's tubercles. Clinical and angiographic study, apropos of a case].

We report a case of miliary tuberculosis in an 11-year-old child, with phlyctenular keratoconjunctivitis and choroidal tubercles in both fundi. Fluorescein angiography showed early hypofluorescence and late moderate hyperflorescence associated with a disseminated choroidis. The presence of these lesions supported diagnosis of tuberculosis in our patient because of their typical clinical and angiographic aspects.

Antitubercular Agents↗
PubMed1997

MRI of the brain in patients with miliary pulmonary tuberculosis without symptoms or signs of central nervous system involvement.

MRI was performed on patients with miliary pulmonary tuberculosis to look for brain involvement and to study the features sequentially, during treatment. We studied seven patients with typical radiographic tuberculosis, and no symptoms or signs of central nervous system involvement. Conventional spin-echo (SE) imaging, including contrast enhanced images, was performed in all cases. All patients showed brain involvement: four patients showed lesions mainly less than 3 mm in diameter, better seen on contrast-enhanced images. These patients showed oedema around the lesions after 2 months of treatment, with subsequent regression on follow-up. The remaining three patients had multiple lesions, 3 mm or more in diameter, which showed a gradual decrease on follow-up. We conclude that the brain may commonly be involved in miliary pulmonary tuberculosis. The response to treatment depends on the stage of the granuloma and shows a definite pattern of healing on follow-up.

Adolescent↗
PubMed1993

Rigors in tuberculosis.

Rigors are not a recognized characteristic of miliary tuberculosis. We report two patients presenting with persistent rigors, thought to be suggestive of acute pyogenic infection, who were subsequently found to have miliary tuberculosis. In both cases, there was significant diagnostic delay. Miliary tuberculosis should therefore be included in the differential diagnosis of any patient presenting with unexplained rigors.

Female↗
PubMed1984

Serum amyloid A protein and C-reactive protein levels in pulmonary tuberculosis: relationship to amyloidosis.

C-reactive protein and serum amyloid A protein levels were measured in 54 patients with pulmonary tuberculosis. The primary tuberculous complex was associated with an insignificant acute phase response, while post-primary tuberculosis without evidence of lung destruction caused modest increases in C-reactive protein and serum amyloid A protein. In most patients with post-primary pulmonary tuberculosis with significant pulmonary destruction there was a major acute phase response, with very high serum amyloid A protein and C-reactive protein levels. The response in these patients is most likely to be due to secondary bacterial infection in addition to infection by Mycobacterium tuberculosis. Patients with miliary tuberculosis showed a major acute phase response. Serum amyloid A protein and C-reactive protein levels decreased rapidly after initiation of treatment in the patients with post-primary tuberculosis without significant pulmonary destruction.

Adolescent↗
PubMed2000

[A case of tuberculous uveitis complicated by myelodysplastic syndrome].

BACKGROUND: Recently, the incidence of tuberculosis in compromised hosts has increased. CASE: A 52-year-old man suffering from myelodysplastic syndrome (MDS) had pulmonary tuberculosis. On June 22, 1996, we found a disc-sized choroidal lesion with milky appearance on the paramacular in his right eye. After 1 month, a similar choroidal lesion was found near the disc in the same eye. In spite of chemotherapy for MDS and antituberculosis medications, those choroidal lesions gradually enlarged. In November, satellite lesions were found around them. Some retinal exudates and hemorrhage were also detected in both eyes. He died on April 6, 1997. We found Langhans' giant cells in the choroid on the specimen of his eyes. So we judged the choroidal lesions to be tuberculous uveitis. CONCLUSION: This case showed choroidal tuberculosis and choroidal miliary tuberculosis in the same eye that were resistant to medications. We thought resistance to medication was due to destruction of the immune system by MDS.

Choroid Diseases↗
PubMed1992

Tuberculous myocarditis presenting as sudden cardiac death.

A 71-year-old Chinese male presented as sudden death and autopsy revealed miliary tuberculosis with tuberculous myocarditis. Though miliary tuberculosis is not as common as in the past, it remains one of the possible causes of sudden cardiac death.

Aged↗
PubMedDate not supplied

Hepatic tuberculosis in absence of disseminated abdominal tuberculosis.

Liver involvement in tuberculosis in absence of miliary tuberculosis is rare. This study was performed to analyse the spectrum and response to treatment of hepatic tuberculosis in the absence of miliary abdominal tuberculosis. Retrospective analysis of seven cases of hepatic tuberculosis without miliary abdominal tuberculosis who presented at the single tertiary referral center were analyzed. All patients presented with fever and hepatomegaly. Five of them had pain in upper abdomen and vomiting. HIV serology was positive in one patient. All patients had normocytic normochromic anaemia, raised erythrocyte sedimentation rate (Mean 65). Mild elevation of liver enzymes and low albumin (Mean 2.4 gm%) with reversal of albumin globulin ratio (Mean 0.6) were seen in all. Two had jaundice. Prothrombin time was normal in all and lactate dehydrogenase values were elevated in all (Mean 794 IU/L). On ultrasonography, 2 had multiple hypodense lesion, 1 had coarse echotexture of liver, 1 had hyperechoic pattern and 3 had just hepatomegaly. Complete resolution of liver lesions on treatment with 4-drug anti-tuberculosis drug chemotherapy was seen. In conclusion, liver tuberculosis has protean manifestations with nonspecific alteration of liver function tests and is best diagnosed on liver biopsy. Overall response to therapy is satisfactory.

Adolescent↗
PubMed1992

A study of tubercular antigen and antibody in childhood tuberculosis.

A radioimmunoassay for the detection of tubercular (TB) antigen (Ag) and antitubercular antibody (Ab) was evaluated for the serodiagnosis of childhood tuberculosis. Children with primary complex, progressive primary complex, miliary tuberculosis, and calcified lung lesions without clinical evidence of active tuberculosis were studied. Significantly elevated levels of TB Ag and TB Ab isolated from the circulating immune complexes were obtained in primary, progressive primary, and miliary tuberculosis patients as compared to controls (P less than 0.01). The majority of patients with calcified lung lesions and without active tuberculosis demonstrated high levels of antibody. It was observed that elevated levels of TB Ag and/or antibodies were present in 54 per cent of patients with primary complex, 94 per cent of patients with progressive disease and 69 per cent of patients with miliary tuberculosis. It is possible that is suspected patients with the above mentioned diseases, a diagnosis can be established by using these techniques.

Antibodies, Bacterial↗
PubMed1989

[Non-healing foot wound].

A young man from Sri Lanka developed a suppurative chronic wound on the right foot after a minor trauma. In spite of several surgical interventions a closure of the ulcer did not occur. Only six months later after serious miliary tuberculosis had developed the correct diagnosis was established and tuberculostatic therapy initiated. This manifestation of tuberculosis--rare in recent times--is reviewed. Emphasis is placed on the causal relation between trauma and reactivation of tuberculosis as well as the pathogenesis of secondary miliary tuberculosis.

Adult↗
PubMed1999

Clinical presentation of tuberculosis and the degree of immunodeficiency in patients with HIV infection.

A retrospective study of 80 HIV patients diagnosed with tuberculosis was carried out in order to evaluate the clinical presentation of tuberculosis (CPT) in relation to the degree of HIV-induced immunodeficiency, as determined by the CD4 lymphocyte count and reactivity to the tuberculin and delayed-type hypersensitivity reaction (DHR) skin tests by applying 2TU of RT-23 tuberculin, and the Muiltest IMC Merieux, respectively. CPT classification was undertaken on the basis of the location of the disease: pulmonary tuberculosis (PT), distinguishing between typical pulmonary (TP) and atypical (AP) according to the radiological pattern; extrapulmonary (ET); mixed tuberculosis (MT) pulmonary and extrapulmonary; and miliary tuberculosis. The CD4 lymphocyte count was 264.6 +/- 226.8, the TP had the highest number (505), MT had 132 (p < 0.001) and the miliary tuberculosis had 148 (p < 0.001), the lowest. The tuberculin skin test was positive in 35%, of which 11% were MT (p < 0.05). In the delayed-type hypersensitivity reaction, 67% were non-normoergic, of which 95% and 100% were MT and miliary tuberculosis, respectively (p < 0.05). There was a good overlap between CD4 depletion and skin tests. TP exhibited moderate immunodeficiency, AP severe immunodeficiency, and mixed and miliary TB extremely high immunodeficiency.

AIDS-Related Opportunistic Infections↗
PubMed2004

A case of choroidal tubercles.

PURPOSE: To report a case of choroidal tubercles in a miliary tuberculosis boy. METHOD: Clinical features description. RESULTS: A 14-year-old boy was found to have multifocal choroidal tubercles. Angiography was performed. He was followed up for 12 months. The choroidal lesions regressed after using anti-tuberculosis drugs for 8 months. Pigment changes remained. CONCLUSION: Tuberculosis may present as a posterior segment inflammation. In miliary tuberculosis, choroid is also a target tissue.

Adolescent↗
PubMed2006

[Lethal complications and associated diseases of rheumatoid arthritis--a retrospective clinicopathologic study of 234 autopsy patients].

OBJECTIVE: Complications and/or associated diseases in rheumatoid arthritis can present atypical clinical manifestations which may lead to an incorrect or delayed diagnosis. The aim of this study was to determine: (1) the complications of rheumatoid arthritis, the accompanying diseases, and the mortality of these, (2) the clinically missed diagnoses of complications and/or associated diseases, (3) the possible links between coexistent complications of rheumatoid arthritis and/or diseases associated with it, furthermore the possible role of these in the mortality of rheumatoid arthritis patients. METHODS: Between 1970 and 1999 10,860 patients died at the National Institute of Rheumatology, and among them 234 with rheumatoid arthritis (diagnosed clinically according to the criteria of the American College of Rheumatology). The associated and basic disease, complication(s), and causes of death were determined on the basis of clinical records and in each case the autopsy findings were confirmed by a review of extensive histological material (50-100 tissue blocks from each patient). RESULTS: The complications of rheumatoid arthritis led to death in 152 (65%) of 234 patients. The complications of RA were clinically recognized in 109 (46.6%, 71.7 rel%) and missed in 43 (18.4% 28.3 rel%) of 152 patients. More than two thirds of lethal complications related to rheumatoid arthritis were diagnosed clinically. The remaining 82 (35%) of 234 rheumatoid arthritis patients died of associated diseases; the cause of death was clinically recognized in 78 (33.3%, 95.1 rel%) of 82 cases. There was a significant and positive correlation (1) between vasculitis and cardiac insufficiency (chi2 = 6.37, p <0.01), vasculitis and tuberculosis (chi2 = 4.18, p <0.04), or miliary tuberculosis (chi2 = 3.86, p <0.04); (2) between tuberculosis and miliary tuberculosis (chi2 = 54.84, p <0.001); and (3) between septic infection and purulent arthritis (chi2 = 97.04, p <0.001). There was a significant and inverse correlation between atherosclerosis and vasculitis (chi2 = 5.10, p <0.02), atherosclerosis and amyloidosis (chi2 = 14.58, p <0.001), or atherosclerosis and septic infection (chi2 = 3.81, p <0.05). There was a significant and inverse correlation between atherosclerosis and lethal cases of vasculitis (chi2 = 9.31, p <0.002), of amyloidosis (chi2 = 6.82, p <0.009), of sepsis (chi2 = 3.81, p <0.05) furthermore, between atherosclerosis with lethal outcome (n = 60 of 106) and vasculitis (chi2 = 12.06, p <0.001), or amyloidosis (chi2 = 13.22, p<0.002), or sepsis (chi2 = 10.82, p <0.001), or purulent arthritis (chi2 = 4.18, p <0.04). CONCLUSION: The most important life threatening complications of rheumatoid arthritis (vasculitis, AA amyloidosis and sepsis) are present and lead to death with higher probability in the younger age group (without atherosclerosis), while in older patients who have atherosclerosis these represent a lower risk of death.

Adolescent↗
PubMed2005

Circulating interleukin-18 and osteopontin are useful to evaluate disease activity in patients with tuberculosis.

BACKGROUND: T helper type 1 (Th1) responses have been implicated in the protective immunity, pathophysiology and development of tuberculosis. However, it is still unclear which molecule(s) reflect disease activity in patients with tuberculosis. METHODS: By specific enzyme immunoassays, circulating interferon-gamma. (IFN-gamma), interleukin-12 (IL-12), IL-18 and osteopontin (OPN) were measured in 47 patients with pulmonary tuberculosis and 7 patients with miliary tuberculosis before anti-tuberculosis therapy, and also measured in 19 patients with tuberculosis before and after anti-tuberculosis therapy. RESULTS: Circulating IFN-gamma, IL-18 and OPN levels were significantly higher in patients with pulmonary tuberculosis than in healthy controls, while there was no significant difference in levels of circulating IL-12 between tuberculosis patients and controls. Circulating IFN-gamma, IL-12, IL-18 and OPN paralleled the extent of lung lesions, and circulating IFN-gamma, IL-18 and OPN paralleled the magnitude of fever in patients with pulmonary tuberculosis. Patients with miliary tuberculosis had extremely high levels of circulating OPN, IFN-gamma and IL-18. Circulating IL-18 and OPN were significantly decreased with anti-tuberculosis therapy, whereas circulating IL-12 and IFN-gamma were not. CONCLUSIONS: Among Th1 response associated molecules, circulating levels of IL-18 and OPN, but not IFN-gamma or IL-12, reflect disease activity in patients with tuberculosis.

Adult↗
PubMedDate not supplied

Magnetic resonance imaging of inflammatory lung disorders: preliminary studies in children.

Magnetic resonance(MR) scans were performed on 14 children with a variety of inflammatory disorders of the lungs. MR successfully identified disease in all of the children and accurately localized the disease within the lung fields. In patients with pneumonia and lung abscesses the acute inflammation was associated with a marked increase in signal intensity on T2 when compared with T1 weighted images. One patient with an inflammatory pseudotumor demonstrated a smaller increase in signal intensity on T2 weighted images than was seen in acute pneumonia. Abscess cavities were well identified along with the wall thickness. In patients with diffuse lung disease (diffuse histoplasmosis, miliary tuberculosis, Letterer-Siwe disease, and allergic alveolitis), each disease appeared different on the MR images. These preliminary studies indicate that magnetic resonance imaging is effective for identifying pulmonary disease in children and may improve the radiologist's ability to differentiate pulmonary disorders.

Adolescent↗
PubMed1994

False positive widal reaction in high-titer disseminated BCG infection.

False-positive Widal reactions following certain non-typhoid Salmonella infections may occur commonly. The case of a patient who developed miliary tuberculosis secondary to intravesical bacillus Calmette-Guérin (BCG) immunotherapy for bladder carcinoma is described. Very high titers of typhoid and paratyphoid agglutinins were obtained with the Widal test; these titers returned to normal after successful anti-tuberculous treatment. This case of high-titer, false-positive Salmonella typhi and Salmonella paratyphi A and B reactions to BCG infection occurred in an area non-endemic for typhoid or paratyphoid fever.

Agglutination Tests↗
PubMed1992

Pulmonary nocardiosis manifested as miliary nodules in a neonate--a case report.

A case of pulmonary nocardiosis in a 18-day-old neonate is presented. The chest roentgenograms demonstrated the widespread nodularities, mimicking miliary tuberculosis. Nocardiosis is rare in childhood but should be included in the differential diagnosis of the disseminated nodularities seen in the chest roentgenogram.

Diagnosis, Differential↗