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[Cryptic miliary tuberculosis. Two case-reports (author's transl)].

C Benit, M Picard, N Brion

    La Semaine Des Hopitaux : Organe Fonde Par L'Association D'Enseignement Medical Des Hopitaux De Paris
    |June 3, 1982
    PubMed
    Summary
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    Cryptic miliary tuberculosis presents without typical signs, often diagnosed late. Early suspicion and liver biopsy are crucial for timely treatment of this severe hematogenous tuberculosis form.

    Area of Science:

    • Infectious Diseases
    • Pulmonology
    • Pathology

    Background:

    • Cryptic miliary tuberculosis is a hematogenous form lacking standard diagnostic criteria, particularly radiological evidence.
    • This presentation poses significant diagnostic challenges, often leading to delayed or posthumous diagnosis.

    Observation:

    • Two cases presented with prolonged fever, malaise, hypotension, hyponatremia, mild liver enzyme abnormalities, and myocarditis.
    • Initial investigations revealed no definitive radiological or biological markers of tuberculosis.
    • Visceral tuberculous localizations manifested later in one patient during treatment and were found pathologically in the other.

    Findings:

    • Key indicators for suspecting cryptic miliary tuberculosis include inappropriate antidiuretic hormone (ADH) secretion, cytopenias (leukopenia or pancytopenia), and hepatic/cardiac involvement.

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  • Liver biopsy is highlighted as a critical diagnostic procedure for identifying occult tuberculous lesions.
  • Diagnostic presumption alone is sufficient to initiate antituberculous therapy.
  • Implications:

    • Recognizing cryptic miliary tuberculosis is vital for managing severe infections of unknown origin.
    • Prompt empirical antituberculous treatment, based on clinical suspicion, can improve patient survival.
    • This condition underscores the importance of considering tuberculosis in complex infectious presentations, even with atypical findings.