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BMJ Case Rep. 2018 May 12;2018. pii: bcr-2017-223360. doi: 10.1136/bcr-2017-223360.

Surprising pathological and clinical manifestations of miliary tuberculosis.

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Department of Medicine, University of Hawaii, Honolulu, Hawaii, USA.
Hospitalist Program, Queen's Medical Center, Honolulu, Hawaii, USA.


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.


gynecological cancer; infection (gastroenterology); tuberculosis; urinary tract infections

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