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Miliary tuberculosis presenting with rigors and developing unusual cutaneous manifestations
K J Lowry1, K T Stephan, C E Davis
1Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas 78234-6200, USA.
Cutis
|August 4, 1999
Summary
Miliary tuberculosis can present with unusual symptoms like rigors and a distinctive skin rash. Prompt antituberculous therapy led to rapid resolution of both fever and the lichenoid tuberculid eruption.
Area of Science:
- Infectious Diseases
- Dermatology
- Internal Medicine
Background:
- Miliary tuberculosis (MTB) is a severe disseminated form of Mycobacterium tuberculosis infection.
- Unusual presenting symptoms of MTB can delay diagnosis and treatment.
- Cutaneous manifestations of tuberculosis are diverse and can mimic other dermatological conditions.
Observation:
- A patient presented with high fevers and rigors, an uncommon initial symptom of miliary tuberculosis.
- A diffuse, erythematous, maculopapular eruption evolved into plaques, consistent with a lichenoid tuberculid.
- Skin biopsies were negative for Mycobacterium tuberculosis; purified protein derivative and anergy panel were non-reactive.
Findings:
- Rigors are a rare presenting symptom of miliary tuberculosis, with limited literature reports.
- The skin lesions, identified as lichenoid tuberculid, were superficial and healed without scarring.
- The patient demonstrated a rapid and positive response to antituberculous therapy.
Implications:
- Recognizing rigors as a potential symptom of miliary tuberculosis is crucial for timely diagnosis.
- Lichenoid tuberculid eruptions, though rare, should prompt consideration of underlying tuberculosis.
- Early initiation of antituberculous treatment is vital for managing disseminated tuberculosis and its cutaneous manifestations.