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[Two cases of miliary tuberculosis with SIADH].
Kekkaku : [Tuberculosis]
|June 1, 1989
Summary
Miliary tuberculosis can cause syndrome of inappropriate antidiuretic hormone secretion (SIADH), leading to hyponatremia. Early diagnosis and treatment of tuberculosis are crucial for managing SIADH and improving patient outcomes.
Area of Science:
- Internal Medicine
- Infectious Diseases
- Endocrinology
Background:
- Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is characterized by hyponatremia due to excessive antidiuretic hormone release.
- Miliary tuberculosis is a disseminated form of tuberculosis that can affect multiple organs.
- SIADH is rarely associated with miliary tuberculosis.
Observation:
- Two cases of miliary tuberculosis presenting with SIADH are reported.
- Case 1: A 70-year-old woman with miliary tuberculosis developed stupor and severe hyponatremia (113 mEq/L).
- Case 2: A 71-year-old man with miliary tuberculosis developed hyponatremia (118 mEq/L) and acute respiratory failure.
Findings:
- Both patients had normal thyroid, renal, and adrenal function, with laboratory data consistent with SIADH criteria.
- Tubercle bacilli were identified in broncho-alveolar lavage fluid and sputum.
- Antituberculous treatment and electrolyte management (NaCl supplementation) led to clinical improvement in both cases.
Implications:
- Miliary tuberculosis should be considered in the differential diagnosis of SIADH, especially in patients with compatible clinical and radiological findings.
- Prompt diagnosis and treatment of miliary tuberculosis are essential for resolving SIADH and preventing neurological complications.
- This highlights the importance of recognizing uncommon causes of SIADH for effective patient management.