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Hypercalcaemia: atypical presentation of miliary tuberculosis.
Edison So1, Dennis Thomas Bolger
1Department of Medicine, University of Hawaii, Honolulu, Hawaii, USA.
BMJ Case Reports
|February 27, 2014
Summary
This case study highlights miliary tuberculosis in an elderly Filipino man, presenting with atypical symptoms and initially negative tests. Diagnosis was confirmed by positive urine acid-fast bacilli (AFB) smear and autopsy findings.
Area of Science:
- Internal Medicine
- Infectious Diseases
- Nephrology
Background:
- Miliary tuberculosis (TB) is a severe disseminated form of Mycobacterium tuberculosis infection.
- Early diagnosis and treatment are crucial but can be challenging due to nonspecific symptoms.
Observation:
- An elderly Filipino male with comorbidities presented with prolonged fever, weakness, and weight loss.
- Initial investigations revealed anemia, hypercalcemia, and acute kidney injury, with chest imaging showing diffuse infiltrates.
- Despite negative sputum and fluid analyses for acid-fast bacilli (AFB), urine AFB smear was positive, leading to diagnosis.
Findings:
- Transbronchial biopsy revealed caseating granulomas, confirming tuberculosis.
- Antituberculosis therapy led to initial clinical improvement but was complicated by small bowel obstruction and respiratory failure.
- Autopsy confirmed disseminated TB in multiple organs, including the remaining kidney.
Implications:
- This case underscores the importance of considering miliary TB in elderly patients with vague symptoms and risk factors.
- A positive urine AFB smear can be a critical diagnostic clue when other samples are negative.
- Disseminated TB can have severe complications, necessitating prompt and comprehensive management.
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