• Tuberculosis and Respiratory Diseases
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• v.59 no.1
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• pp.109-113
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• 2005

Miliary tuberculosis is the most serious form of tuberculous disease, but is rarely complicated with acute respiratory distress syndrome (ARDS). When a patient with miliary tuberculosis initially presents with ARDS, the mortality is much higher. Therefore, the early detection of miliary tuberculosis as the underlying cause of ARDS is very important for the prognosis and survival of the patient. The diagnosis of miliary tuberculosis may be easy if the patient presents typical clinical manifestations associated with the characteristic pattern of miliary nodules on chest radiology. However, the diagnosis of miliary tuberculosis when complicated with ARDS can be difficult due to the nonspecific radiologic patterns, such as diffuse bilateral consolidation and ground glass opacity, without miliary nodular infiltration. However, these nonspecific patterns are known as less likely findings of miliary tuberculosis. We experienced a pregnant woman with miliary tuberculosis, mimicking ARDS due to bilateral severe pneumonia. She was admitted, via the emergency room, with sudden onset of fever, chill, cough and dyspnea. The initial chest PA and HRCT showed diffuse bilateral consolidation and ground glass opacity, without miliary nodular infiltration. All bacteriological studies, including blood and sputum cultures, tuberculosis-PCR and serologic study for infectious disease were negative. However, the definite diagnosis of unusual miliary tuberculosis as the underlying cause of ARDS was confirmed from the radiological finding and transbronchial fiberoptic lung biopsy. We report this case, with a review of the literature.

• The Korean Journal of Nuclear Medicine
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• v.26 no.1
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• pp.111-115
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• 1992

Miliary Tuberculosis is an illness produced by acute dissemination of tubercle bacilli via the blood stream. In chest roentgenogram, a diffuse "miliary" infiltrates are usually seen, but normal or suspicious ground glass pattern also can be seen in early manifestation. Ten patients of miliary tuberculosis who underwent whole-body $^{67}Ga-citrate$ scintigraphy were evaluated retrospectively to study usefulness of Ga-scan for early diagnosis of miliary Tbc and evaluation of disease activity. All of ten patients demonstrated significantly diffuse bilateral pulmonary uptakes on 48 hours image. All of three patients of ground-glass pattern in chest roentgemogram also demonstrated increased uptakes. In the statistical analysis, the severity of chest roentgenographic findings showed positive correlation with the activity on Ga?scan. These results suggest that Gallium scan is useful for diagnosis of early miliary tuberculosis and for evaluation of disease activity on follow-up examination of miliary tuberculosis of lung.

• Pediatric Infection and Vaccine
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• v.8 no.2
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• pp.247-252
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• 2001

Although the incidence of tuberculosis has been decreased, it is still an important community acquired infectious disease in the world. Miliary or disseminated tuberculosis occurs from the inadequacy of host defense in controling tuberculous infection. Generally, brain parenchyme has been considered to be a rare involving organ than other organs or meninges in miliary tuberculosis. However it has been proving that the brain parenchyme is commonly involved organ in miliary tuberculosis even without neurological manifestations. We report a case of 8 yr-old male patient, who was diagnosed as having an miliary tuberculosis with multiple tuberculoma throughout the brain. The tuberculous lesions of lung and brain were nearly cleared within 3 months with anti-tuberculous therapy. With a reveiw of related literatures, we suggest that the patients with miliary tuberculosis should be evaluateded about brain involvement.

• Tuberculosis and Respiratory Diseases
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• v.42 no.5
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• pp.654-659
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• 1995

Background: Tuberculosis has commonly been associated with various hematologic changes. A difference between the changes found in pulmonary tuberculosis and those found in miliary tuberculosis has been discussed. Up to now some worker were investigated hematological changes associated with pulmonary tuberculosis but was not investigated those associated with miliary tuberculosis in korea. Therefore we examimed the peripheral blood and bone marrow findings in miliary tuberculosis patients to determine hematologic changes. Methods: We performed blood sample at admission and bone marrow biopsy within 7days after admission. For evaluation of the hematologic findings, full blood counts and marrow differential counts were defined by the criteria outlined by Dacie and Lewis. Results: 1) Peripheral blood findings: Pancytopenia in 10% of patients, anemia in all patients, leukocytosis in 10% of patients, leukopenia in 20% of patients, thrombocytopenia in 30% of patients, lymphocytopenia in 90% of patients, monocytosis in 40% of patients and neutrophilia in 10% of patients were found at peripheral blood. 2) Bone marrow findings: Lymphocytopenia in 30% of patients, lymphocytosis in 20% of patients, plasmacytosis in 40% of patients, monocytosis in 100% of patients, and hypocellularity in 30% of patients were found at bone marrow. Erythropoiesis was decreased in 30% of patients. Granulopoiesis was decreased in 20% of patients and increased in 20% of patients. Bone morrow granuloma occured in 25% of patients. Conclusion: Hematologic changes of miliary tuberculosis were seen tendency of cytopenic pattern but monocyte was increased at peripheral blood and bone morrow. This findings would provide additional information for the differential diagnosis of miliary tuberculosis.

• Tuberculosis and Respiratory Diseases
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• v.67 no.2
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• pp.127-130
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• 2009

Bilateral interstitial infiltration in chest radiography, which may be fine granular, reticular or of ground glass opacity, is the typical radiographic findings of Pneumocystis jiroveci pneumonia. Recently, atypical radiographic features, including cystic lung disease, spontaneous pneumothorax or nodular opacity, have been reported intermittently in patients with P. jiroveci pneumonia. We report the case of a 29-year-old woman with a transplanted kidney whose simple chest radiography and HRCT scan showed numerous miliary nodules in both lungs, mimicking miliary tuberculosis (TB). Under the presumptive diagnosis of miliary TB, empirical anti-TB medication was started. However, Grocott methenamine silver nitrate staining of a transbronchial lung biopsy tissue revealed P. jiroveci infection without evidence of TB. These findings suggest that even in TB-endemic area other etiology such as P. jiroveci as well as M. tuberculosis should be considered as an etiology of miliary lung nodules in mmunocompromised patients.

• Pediatric Infection and Vaccine
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• v.7 no.2
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• pp.250-256
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• 2000

The incidence of tuberculosis has been decreased, and especially the incidence of severe complicated tuberculosis has been markedly decreased as the result of widely used BCG vaccines. But tuberculosis is still an important community accquired infectiouse disease in the world despite continued worldwide efforts to control the disease. Miliary tuberculosis, the most serious complicated tuberculosis, can be occurred by lymphohematogenous dissemination of tuberculosis, and intracranial tuberculoma with or without tuberculosis meningitis can be developed in case of miliary tuberculosis. In general, serious tuberculosis infections such as miliary tuberculosis and CNS tuberculosis are developed especially in young infants and children in cases of delayed diagnosis and treatment despite receiving BCG vaccination, and usually those patients have contact sources. Intrcranial tuberculoma in children are usually found near infratentorial site at the base of cerebellum, and clinically symptoms and signs of increased intracranial pressure developed before treatment. Serial brain CT or MRI is a good non-invasive diagnostic modality of intracranial tuberculoma. Although surgical intervention was initially advocated as the mainstay of intracranial tuberculoma therapy, but many recent clinical studies indicate that intracranial tuberculoma can be cured with medical treatment alone. We experienced a case of 3 months old male patient, who was diagnosed as having miliary tuberculosis associated with multiple intracranial tuberculoma. He received BCG vaccination at 4 weeks after birth, and his father was confirmed as active pulmonary tuberculosis patient after this patient's admission. We report this case with a review of related literatures.

• Tuberculosis and Respiratory Diseases
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• v.76 no.5
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• pp.245-248
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• 2014

Miliary tuberculosis (TB) is a rare extrapulmonary form of TB, and there have been only two reports of miliary TB associated with infection with multidrug-resistant (MDR)-TB pathogen in an immunocompetent host. A 32-year-old woman was referred to our hospital because of abnormal findings on chest X-ray. The patient was diagnosed with MDR-TB by a line probe assay and was administered proper antituberculous drugs. After eight weeks, a solid-media drug sensitivity test revealed that the pathogen was resistant to ethambutol and streptomycin in addition to isoniazid and rifampicin. The patient was then treated with effective antituberculous drugs without delay after diagnosis of MDR-TB. To the best of our knowledge, this is the first case of miliary TB caused by MDR-TB pathogen in Korea.

• Tuberculosis and Respiratory Diseases
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• v.40 no.5
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• pp.558-564
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• 1993

Background: Gallium scans was used clinically for detection of inflammatory lesion, granulomatous process and neoplasm and inflammatory activity in interstitial disease. So we had perfomed $Ga^{67}$ scan to see the finding of $Ga^{67}$ scan in miliary tuberculosis and to correlate $Ga^{67}$ uptake with that of the chest PA and the clinical severity. Method: We examined 10 patients who were confirmed as having miliary tuberculosis, with $Ga^{67}$ scan, chest PA and arterial blood gas analysis. Results: 1) Diffuse, positive gallium uptake was seen in all cases of miliary tuberculosis. 2) In most of cases, gallium uptake was noted only at the lung field in spite of hematogenous spread of tuberculous foci. 3) The strong correlation between chest PA and $Ga^{67}$ scan finding was seen. 4) The intimate correlation between arterial hypoxemia and $Ga^{67}$ scan finding was also noted. Conclusion: Gallium scan showed diffuse pulmonary uptake in all cases of miliary tuberculosis and it may provid a useful information to assess the disease severity in miliary tuberculosis.

• Tuberculosis and Respiratory Diseases
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• v.68 no.4
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• pp.218-225
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• 2010

Background: Bronchoalveolar lavage (BAL) is a useful technique to recover lower airway fluid and cells involved in many respiratory diseases. Miliary tuberculosis is potentially lethal, but the clinical manifestations are nonspecific and typical radiologic findings may not be seen until late in the course of disease. In addition, invasive procedures are often needed to confirm disease diagnosis. This study analyzed the cells and the T-lymphocyte subset in BAL fluid from patients with miliary tuberculosis to determine specific characteristics of BAL fluid that may help in the diagnosis of miliary tuberculosis, using a less invasive procedure. Methods: On a retrospective basis, we enrolled 20 miliary tuberculosis patients; 12 patients were male and the mean patient age was $40.5{\pm}16.2$ years. We analyzed differential cell counts of BAL fluid and the T-lymphocyte subset of BAL fluid. Results: Total cells and lymphocytes were increased in number in the BAL fluid. The percentage of CD4+ Tlymphocytes and the CD4/CD8 ratio in BAL fluid were significantly decreased and the percentage of CD8+ T-lymphocytes was relatively higher. These findings were more prominent in patients infected with the human immunodeficiency virus (HIV). In the HIV-infected patients, the proportion of lymphocytes was significantly higher in BAL fluid than in peripheral blood. There were no significant differences between the BAL fluid and the peripheral blood T-lymphocytes subpopulation. Conclusion: BAL fluid in patients with miliary tuberculosis demonstrated lymphocytosis, a lower percentage of CD4+ T-lymphocytes, a higher percentage of CD8+ T-lymphocytes, and a decreased CD4/CD8 ratio. These findings were more significant in HIV-infected subjects.

• Tuberculosis and Respiratory Diseases
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• v.42 no.2
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• pp.244-249
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• 1995

We experienced one case of pulmonary lymphangioleiomyomatosis in 26-year-old female patient. She had taken antituberculous medication under the impression of miliary tuberculosis on simple chest X-ray at peripartum period. On outpatient follow-up she complained of progressive exertional dyspnea in spite of medication. Through careful history taking and physical examination, high resolutional CT, and open lung biopsy she was diagnosed as pulmonary lymphangioleiomyomatosis combined with incomplete type of tuberous sclerosis. So, we presented the case with the brief review the literatures.