Miliary Pulmonary Tuberculosis Research Articles

Thrombose veineuse cérébrale aseptique et tuberculomes cérébraux compliquant une miliaire tuberculeuse pulmonaire

Severe pulmonary tuberculosis may be complicated by deep vein thrombosis due to a state of hypercoagulability.We report a case of pulmonary miliary tuberculosis associated with cerebral venous thrombosis and multiple intracranial tuberculomas. A 65-year-old woman developed a confusional syndrome one week after starting treatment for pulmonary military tuberculosis. Neuroimaging reveals a thrombus in the right lateral sinus and multiple silent intracranial tuberculoma.The patient was given anticoagulants and fully recovered.

A Case of Accelerated Silicosis Mimicking Miliary Pulmonary Tuberculosis

Silicosis is a chronic fibrosing lung disease that is initiated by prolonged and extensive exposure to respirable free crystalline silica. Accelerated silicosis is rare and is clinically identical to the classic form of silicosis with the exception that the time from initial exposure to the onset of the disease is shorter and the rate of disease progression is drama- tically faster. We describe a case of accelerated silicosis, which mimicked miliary pulmonary tuberculosis. The patient had worked in a mine coal for a period of 9 years. Subsequently, he worked in construction dealing with cement and sand for 14 years until he visited this clinic. The clinical course was notable for the rapid progression of the radiological features of silicosis over a period of 2 months. Polarizing light microscopic studies of the biopsied specimens by a transb- ronchial lung biopsy showed polarizing particles, which were typical of silica. To the best of our knowledge, this is the first case report of accelerated silicosis in Korea. (Tuberc Respir Dis 2005; 59: 684-689)

Tuberculosis of the Nasopharynx: A Rare Entity Revisited

Tuberculosis of the nasopharynx is uncommon. A large series of 17 cases is reported, and the clinical and pathological features are discussed. A retrospective review. Seventeen archived cases of biopsy-proven nasopharyngeal tuberculosis were reviewed for patient age and sex, presenting complaint and duration, systemic symptoms, cervical lymphadenopathy, and chest x-ray findings. These findings were compared with a compilation of 40 cases reported in the English literature. There was a female predominance (13 women and 4 men), with age range of 20 to 74 years (mean age, 38 y). The most common presentation was enlargement of the cervical lymph nodes (53%), followed by hearing loss (12%), tinnitus, otalgia, nasal obstruction, and postnasal drip (6% each). The duration of the presenting symptoms ranged from 1 week to 1 year (mean duration, 16 wk). Ten patients (59%) had cervical lymphadenopathy, two (12%) had systemic symptoms (fever, weight loss, night sweats), and one patient (6%) had miliary pulmonary tuberculosis. Direct endoscopic examination showed nasopharyngeal mucosal irregularity or mass in the majority of patients (12 patients [70%]). These features were similar to those reported in the literature. Nasopharyngeal tuberculosis is uncommon, usually occurring without pulmonary or systemic involvement. Cervical lymphadenopathy occurs in more than half of the patients and is the most common presenting complaint; this, together with the nasopharyngeal findings of mass or mucosal irregularity, makes differentiation from carcinoma on clinical examination difficult, necessitating histological evaluation.

Tuberculous Abscess of the Pancreas Presenting as Obstructive Jaundice: A Case Report

Pancreatic tuberculosis is very rare, though dissemination to the gastrointestinal tract and mesenteric lymph nodes is common. We describe a case of pancreatic tuberculosis presenting as a cystic mass in the pancreatic head, with biliary obstruction, in a patient with miliary pulmonary tuberculosis. Surgery for the curative treatment of jaundice was performed, and the histopathologic findings indicated that a pancreatic abscess with caseous necrosis was present, consistent with tuberculosis

Pulmonary miliary tuberculosis in a patient with anti-TNF-alpha treatment

No difference in the number of serious adverse events was reported in previous clinical trials in rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) patients treated with TNF-alpha blockade, but a patient died because of disseminated tuberculosis. A tuberculosis reactivation in a patient with IBD and anti-TNF-alpha treatment has been recently reported. Very recently 70 cases of tuberculosis were reported from the FDA Adverse Event Reporting System. We report a case of pulmonary miliary tuberculosis in a RA patient treated with TNF-alpha blockade. The important role of TNF-alpha in defence against tuberculosis and possible mechanisms of anti-TNF-alpha agents impairing tuberculosis immune response are discussed.

Sequential Radiographic Changes of Nodules in Patients with Miliary Pulmonary Tuberculosis

Sequential Radiographic Changes of Nodules in Patients with Miliary Pulmonary Tuberculosis

Pulmonary miliary tuberculosis with multiple intracerebral tuberculous granulomas-report of two cases

Although intracerebral tuberculomas are common in countries where tuberculosis is still endemic, miliary tuberculosis with involvement of the central nervous system is exceptionally rare. We report two cases of pulmonary miliary tuberculosis with multiple intracerebral tuberculomas.

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.

T Helper Cell Alveolitis after Bacillus Calmette-Guerin Immunotherapy For Superficial Bladder Tumor

We report a case of T helper cell alveolitis after intravesical bacillus Calmette-Guerin (BCG) immunotherapy for a superficial bladder tumor. Despite the clinical appearance of miliary pulmonary tuberculosis no myobacterial agent was found. Therefore, we concluded that the patient had a hypersensitivity reaction similar to sarcoidosis. The condition improved after immunosuppressive therapy with glucocorticosteroids. Differentiation of bronchoalveolar cells could be useful in distinguishing hypersensitivity to infection with BCG.

Age-Related Changes in the Manifestations of Tuberculosis

Although the overall number of tuberculosis cases reported in developed countries has decreased markedly since about the middle of the twentieth century, at present active tuberculosis in the geriatric population is highly prevalent even in developed countries. With an increase in the aged population and striking progress in medicine during the past two decades, the development of tuberculosis infections and the active disease has been gradually changed; namely, the number of older people at risk of infection has been increasing. In the elderly, postprimary pulmonary tuberculosis and miliary tuberculosis are particularly difficult to diagnose. A high index of suspicion, a tuberculin skin test, and appropriate laboratory studies are essential for early diagnosis. In choosing the proper therapy for tuberculosis in the elderly, efficacy, patient compliance, and toxicity must be considered. During this decade, more so than ever before, much time and work will be required to more completely understand the factors that place a patient at risk for infection and to accomplish eradication of tuberculosis.

Paradoxical Response of Intracranial Tuberculoma during Treatment

Paradoxical Response of Intracranial Tuberculoma during Treatment

Two Cases of Brain Tuberculoma Associated with Miliary Pulmonary Tuberculosis

Two Cases of Brain Tuberculoma Associated with Miliary Pulmonary Tuberculosis

A Case of Multiple Brain Tuberculoma associated with Miliary Pulmonary Tuberculosis

A Case of Multiple Brain Tuberculoma associated with Miliary Pulmonary Tuberculosis

A Follow-up of Tuherculous Meningitis in Adults

This study is based on data from the 63 cases of tuberculous meningitis treated by the authors during the past seven years. Tuberculous meningitis was found to be more frequent in women especially about the age of twenty. The combined mostly triple chemotherapy using large dosage of INH was continued for 6 to 18 months or more.In some cases cortisone or prednisolone was also used. The effects of chemotherapy were excellent in most cases. Early treatment was important, but late treatment also resulted frequently in good effects. As the complications pulmonary tuberculosis, miliary tuberculosis and paralysis of the ocular muscles were observed very often. As the sequelae hearing disturbance, deterioration of the memory and atrophy of the optic nerve were observed occasionally.

Miliary Tuberculosis and Hodgkins Disease: Case Report with Autopsy Findings

Since Sternberg’s1 description of Hodgkin’s disease in 1898, attention has been focused on the question of its relation to tuberculosis. Ewing’s2 dictum “tuberculosis follows Hodgkin’s disease like a shadow” would lead one to believe that there is an etiological relationship between these two diseases. However, we now know that the occurrence of these two diseases in one individual is merely a coincidence. It is interesting to note that Hodgkin’s disease may resemble tubercullosis in many ways: hilar lymph node involvement may simulate the glandular enlargement of primary pulmonary tuberculosis; pleural involvement may be confused with tuberculous pleurisy with effusion; miliary type of Hodgkin’s disease may be misdiagnosed as miliary tuberculosis; involvement of cervical lymph nodes may be confused with tubercubus cervical adenitis. This report deals with a patient who had been known to have Hodgkin’s disease for 10 years prior to the development of miliary pulmonary tuberculosis in October, 1952. The miliary tuberculosis was treated successfully with long term chemotherapy, streptomycin sulfate and para-amino-salicylic acid, and no trace of recognizable tuberculosis remained on autopsy examination. The primary cause of death was Hodgkin’s disease and death occurred 11 years after this disease was originally diagnosed.

Selecting the Streptomycin Regimen for Patients with Pulmonary Tuberculosis with Special Reference to the Intermittent Dosage Schedule

On the basis of current streptomycin research studies at Fitzsimons General Hospital, certain tentative conclusions regarding the type of streptomycin regimen to select in the treatment of patients with pulmonary tuberculosis seem justified, as follows: 1) We should use the shortest course of streptomycin therapy which will accomplish our purpose, in order that we may reduce the number of cases developing “bacterial resistance.” 2) That short courses (30–60 days) of streptomycin are satisfactory for most cases of pulmonary tuberculosis with recent exudative lesions. 3) That long courses (60–120 days) of streptomycin are better and often required in the treatment of patients with caseous pneumonic tuberculosis (particularly severe acute lobar or lobular pneumonia). In these cases where streptomycin may prove to be life saving, the danger of “bacterial resistance” must be disregarded. 4) That long courses of treatment or interrupted short courses of streptomycin over a long period of time are required for miliary pulmonary tuberculosis with or without meningitis. 5) That the intermittent streptomycin schedule 1 using one or two grams of the drug every third day for one to four months, will give clinical and roentgenological results comparable to those obtained by one or two grams daily dosage schedules over similar periods of time, without significant toxic reactions to the drug. In addition, the important factor of delaying the emergence of streptomycin resistant organisms is proved. In our series, no case with “bacterial resistance” developed in 42 days; only 3.9 per cent at 60 days; 4.2 per cent at 70 days; 8 per cent at 80 days; 18 per cent at 90 days; 24 per cent at 100 days; and 33 per cent at 120 days. In other words, this effective method of using the drug can be utilized for a prolonged period with less danger of encountering “bacterial resistance” than from any of the other regimens reported upon in this study. The intermittent regimen can be used for periods of from one to four months or longer, either continuously or in interrupted short courses, depending upon the purpose for which it is prescribed. Of all courses of streptomycin therapy studied at Fitzsimons General Hospital, it appears to have the greatest utility in the management of all forms of pulmonary tuberculosis (exclusive of miliary tuberculosis), whether its purpose be for definitive treatment, as an adjunct to operative procedures, for symptomatic relief, or as a therapeutic trial. (Research studies are now being made with the intermittent streptomycin schedules combined with 12 grams of para-aminosalicylic acid (PAS) orally daily, in the hope of still further delaying the emergence of drug resistant organisms).

Fundus Lesions in Tuberculous Meningitis and Miliary Pulmonary Tuberculosis Treated with Streptomycin

Fundus Lesions in Tuberculous Meningitis and Miliary Pulmonary Tuberculosis Treated with Streptomycin

Healed Miliary Pulmonary Tuberculosis

Healed Miliary Pulmonary Tuberculosis

Miliary pulmonary tuberculosis with recovery

Miliary pulmonary tuberculosis with recovery