Miliary Tuberculosis

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Abstract
Cases (26) of miliary tuberculosis were studied in retrospect. Mean age of the patients was 62 yr. Eighteen patients suffered from another underlying chronic disease. Nine were treated with corticosteroids or cytotoxic agents. A limited manifestation of tuberculosis was previously verified or suspected in 10 cases. Fever was present in 85% of the patients, frequently combined with fatigue or abdominal pain. Serum alkaline phosphatase was elevated in 81% of the cases. Minor hematological abnormalities (anemia, etc.) were found in 16 cases and pancytopenia, stimulated lymphocytes or chronic myeloid leukemia in 6. Miliary mottling was found in chest radiographs of 13 patients. Other findings were pleural effusion, mediastinal node enlargement, opacities suggesting pneumonia or old, possibly tuberculous lesions. Antituberculosis therapy was initiated in 12 patients, 2 of whom died within a few days. There was a high frequency of liver or system involvements. Laparoscopy or liver needle biopsy are valuable diagnostic procedures in patients with fever and elevated alkaline phosphatases of unknown etiology. A therapeutic test with anti-tuberculous drugs should be undertaken in suspected cases.