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Miliary Tuberculosis: A Case Report Highlighting the Diagnostic Challenges Associated With the Condition
Usman Ilyas1, Abrahim Mahmood2, Amee M Pansuriya3
1Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Jamaica, USA.
Cureus
|October 24, 2022
Summary
Tuberculosis is difficult to diagnose in dialysis patients due to vague symptoms and can mimic other diseases. This case highlights the challenges in diagnosing miliary tuberculosis, emphasizing the need for high suspicion.
Area of Science:
- Nephrology
- Infectious Diseases
- Pulmonology
Background:
- End-stage renal disease (ESRD) patients on chronic dialysis are immunocompromised, increasing tuberculosis (TB) risk.
- Tuberculosis is challenging to diagnose due to non-specific symptoms and frequent extrapulmonary involvement.
- Miliary tuberculosis, with poor prognosis if delayed, presents diagnostic hurdles.
Observation:
- A patient with ESRD on dialysis presented with chronic diarrhea and fecal incontinence.
- Initial interferon-gamma release assay testing was negative.
- The patient's presentation mimicked malabsorption syndromes, neoplasia, and autoimmune disorders, necessitating extensive testing.
Findings:
- The patient had miliary tuberculosis, affecting multiple organ systems.
- Diagnosis was significantly delayed due to the atypical presentation and broad differential diagnosis.
- Despite extensive investigations, the patient unfortunately demised.
Implications:
- This case underscores the importance of maintaining a high index of suspicion for tuberculosis, even with negative initial tests.
- It highlights the diagnostic challenges posed by miliary tuberculosis in immunocompromised patients.
- Prompt diagnosis and treatment are crucial, especially in resource-rich settings where TB is less common.
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