Miliary TB Without Microbiological Confirmation in a Post-Menopausal Female: A Case From a High-Burden Region

Area of Science:

• Medicine
• Radiology
• Infectious Diseases

Background:

• Miliary tuberculosis (TB) poses diagnostic difficulties, especially in resource-limited settings.
• Microbiological confirmation is often unattainable, complicating diagnosis and treatment.
• High TB prevalence in regions like Nepal necessitates consideration of alternative diagnostic approaches.

Purpose of the Study:

• To highlight the utility of computed tomography (CT) imaging in diagnosing miliary TB.
• To emphasize the role of empirical treatment when microbiological confirmation is not feasible.
• To present a case study of miliary TB in an elderly patient from a high-burden region.

Main Methods:

• Case report of a 65-year-old post-menopausal woman presenting with prolonged fever, anemia, and constitutional symptoms.
• Initial chest radiography was inconclusive; contrast-enhanced computed tomography (CECT) revealed diffuse miliary nodules, calcified lymphadenopathy, and pleural effusion.
• Empirical anti-TB therapy was initiated based on radiological findings and epidemiological context due to limitations in obtaining microbiological confirmation.

Main Results:

• CECT imaging was crucial in identifying diffuse miliary nodules, calcified lymphadenopathy, and pleural effusion, suggestive of miliary TB.
• The patient received empirical anti-TB therapy (isoniazid, rifampicin, pyrazinamide, ethambutol).
• Symptomatic and hematological improvement was observed during follow-up, despite challenges with invasive diagnostics.

Conclusions:

• CT imaging plays a vital role in diagnosing miliary TB when microbiological evidence is unavailable.
• Empirical treatment is a viable and ethical option for elderly patients in endemic regions with diagnostic limitations.
• This case underscores the importance of integrating radiological findings with clinical context for managing miliary TB in resource-limited settings.