Miliary tuberculosis in a young Caucasian adult

A young Caucasian adult presented to the Accident and Emergency department with small bowel obstruction, which necessitated an exploratory laparotomy. Multiple firm nodules were found with biopsies leading to a diagnosis of peritoneal tuberculosis (TB). Retrospectively, the patient was noted to have classical radiological pulmonary TB findings on a chest radiograph 3 months previously, and 2 weeks later had developed bony infiltration, paravertebral abscesses and likely TB skin lesions. This case illustrates an unusual presentation in a patient with minimal risk factors yet widespread extra-pulmonary disease. It also highlights the importance of attentive reviewing of x-rays.