[Late disseminated tuberculosis. Anatomo-clinical correlations in 40 cases]

Late disseminated tuberculosis has a diversity of clinical presentations and is difficult to diagnose. This disease has a growing importance in industrialised countries and we decided to study forty cases correlating autopsy findings with the clinical date. This diffuse form of miliary tuberculosis occurs long after the primary infection. It is a disease of the elderly (72.5% greater than 65, 32.5% greater than 80). It represented 42.5% of serious tuberculous cases observed at autopsy over the same period. At the top of the list of clinical presentations is fever (57.5%) followed by loss of weight (42.5%) and respiratory symptoms (32.5%). The diagnosis of tuberculosis was only considered in 37.5% of cases (15/40), however the pulmonary radiograph suggested the diagnosis in the majority of cases. In 62.5% of cases (25/40) tuberculous disease was not recognised in the clinic, the presenting symptomatology was attributed in nearly half the cases to neoplastic disease. Autopsy showed that the primary disease was caseous tuberculosis in 25% of cases and in 25% there was a cancer. Our observations underline the diagnostic challenge of late disseminated tuberculosis in clinical practice and also discern the particular clinical characteristics and anatomo-pathological features.