An unusual presentation of miliary tuberculosis

Area of Science:

• Internal Medicine
• Infectious Diseases
• Pulmonology

Background:

• Pelvic inflammatory disease (PID) is a common gynecological infection.
• Acute respiratory distress syndrome (ARDS) can arise from various systemic infections.
• Tuberculosis (TB) can present with diverse and atypical symptoms.

Observation:

• A young Bangladeshi woman presented with vaginal discharge, fever, and rigors.
• Initial treatment for PID did not resolve symptoms, and the patient deteriorated.
• Rapid development of respiratory failure and ARDS was noted.

Findings:

• Axillary biopsy and high-resolution CT chest confirmed miliary tuberculosis (TB).
• Miliary TB, a disseminated form of TB, was the underlying cause of the patient's severe illness.
• Diagnosis was challenging due to atypical initial presentation.

Implications:

• This case underscores the importance of considering disseminated tuberculosis in patients with unexplained ARDS and systemic symptoms.
• Early and accurate diagnosis of miliary TB is crucial for effective management and improved patient outcomes.
• Highlights the need for a broad differential diagnosis in infectious disease presentations.