Puzzled Picture, Perilous Miliary Tuberculosis: A Case Report

Abstract

Miliary tuberculosis is a disseminated form of tuberculosis that poses a high risk of mortality and morbidity if notdiagnosed and treated promptly within the first year of onset. This case report describes a 72-year-old male who presented withnon-specific symptoms, including easy fatigability, weight loss, anorexia, right hypochondrial pain for three months, and fever forthree weeks. Initial evaluation with CECT abdomen revealed cholelithiasis with a dilated common bile duct (CBD), leading to theinitiation of intravenous antibiotics and an ERCP to drain stones. Despite these interventions, the patient's fever and symptomspersisted. Further investigations for pyrexia of unknown origin revealed multiple miliary nodules on the CT chest, confirming thediagnosis of miliary tuberculosis. Anti-tuberculosis therapy was promptly initiated, and the patient exhibited significantsymptomatic improvement within one month of follow-up. This case highlights a rare and atypical presentation of miliarytuberculosis associated with cholelithiasis, which posed diagnostic challenges. Persistent fever and unexplained symptoms,despite addressing other coexisting conditions, should prompt consideration of miliary tuberculosis, especially in elderly patientswith risk factors. Early use of imaging, such as CT chest, plays a critical role in identifying miliary nodules indicative ofdisseminated tuberculosis. Immediate initiation of anti-tuberculosis therapy following diagnosis significantly improves patientoutcomes. Clinicians should maintain a high index of suspicion for miliary tuberculosis in cases presenting with pyrexia ofunknown origin or atypical symptoms, even when other diagnoses, such as cholelithiasis, are evident. Comprehensive evaluationusing advanced imaging and timely initiation of appropriate therapy is essential to ensure effective management and reduce therisk of adverse outcomes in such complex cases.