Abstract
We report a surprising pathological finding of miliary tuberculosis (TB) in a 49-year-old Chuukese, immunocompetent woman who was initially admitted to the hospital for a 1-month duration of chronic abdominal pain and intermittent fevers. Her clinical symptoms did not improve despite treatment with vancomycin and piperacillin-tazobactam. Based on the primary abdominal CT findings suggesting advanced ovarian cancer with omental metastatic disease, further workup with omental core biopsy was performed and demonstrated acute neutrophilic necrosis without malignant cells or granulomata. Within the omental tissue, however, many organisms stained positive for acid-fast bacilli despite lack of typical granulomata. The diagnosis of genitourinary TB was confirmed by urine Mycobacterium tuberculosis/rifampin automated molecular rapid nucleic acid amplification test. The chest CT showed a millet seed pattern of infiltration which is a hallmark for miliary TB. After initiation of multidrug TB therapy, her fever and abdominal pain drastically improved.
References
Jan 1, 1974·The Journal of Allergy and Clinical Immunology·S J ZeitzP P Van Arsdel
Jan 1, 1980·Chest·D N McMurray
Oct 3, 2003·The Lancet Infectious Diseases·W Michael Scheld
Aug 25, 2004·Trends in Immunology·Graham A W RookGeok Teng Seah
Jan 16, 2007·Medicine·Jann-Yuan WangKwen-Tay Luh
Jan 16, 2009·MMWR. Morbidity and Mortality Weekly Report·UNKNOWN Centers for Disease Control and Prevention (CDC)
Feb 28, 2009·American Journal of Respiratory and Critical Care Medicine·Prabhat K SharmaDipendra K Mitra
Sep 10, 2010·The New England Journal of Medicine·Catharina C BoehmeMark D Perkins
Apr 2, 2011·Mayo Clinic Proceedings·Irene G Sia, Mark L Wieland
Jun 2, 2012·Frontiers in Bioscience (Landmark Edition)·Shuliang Guo, Zhi Ao
Apr 4, 2014·The European Respiratory Journal·Claudia M DenkingerKaren R Steingart
Sep 10, 2014·The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease·S BamrahS Mase
Apr 11, 2015·Tuberculosis and Respiratory Diseases·Ji Yeon Lee
Nov 4, 2015·JAMA : the Journal of the American Medical Association·Robert D KirkcaldyJohn R Papp
Nov 26, 2015·The New England Journal of Medicine·C Robert HorsburghChristoph Lange
Oct 27, 2017·Drug Delivery·Xueqin Zhang, Gangliang Huang