Miliary tuberculosis in an Indian lady: Looking beyond miliary tuberculosis

Area of Science:

• Pulmonology
• Infectious Diseases
• Radiology

Background:

• Miliary shadows on chest imaging are frequently attributed to miliary tuberculosis.
• Empirical anti-tubercular therapy is often initiated for suspected miliary tuberculosis, particularly when sputum tests are negative.
• Human immunodeficiency virus (HIV) infection can complicate diagnosis and treatment.

Purpose of the Study:

• To present a case of miliary infiltrates with an alternative diagnosis in an HIV-infected patient.
• To emphasize the diagnostic challenges and the need for vigilance against mimics of tuberculosis.

Main Methods:

• Case report of a young female with HIV infection presenting with miliary infiltrates.
• Initiation of empirical anti-tubercular therapy (ATT).
• Subsequent invasive sampling for definitive diagnosis.

Main Results:

• The patient presented with miliary infiltrates on chest radiography.
• Empirical ATT was initiated due to suspicion of miliary tuberculosis.
• An alternative diagnosis was established through invasive sampling, leading to the discontinuation of ATT.

Conclusions:

• Miliary infiltrates in HIV-infected individuals may not always indicate tuberculosis.
• Physicians must maintain a high index of suspicion for alternative diagnoses that mimic miliary tuberculosis.
• Invasive sampling is crucial for accurate diagnosis and appropriate management, avoiding unnecessary anti-tubercular therapy.