Miliary tuberculosis presenting with hyponatremia and thrombocytopenia

Area of Science:

• Internal Medicine
• Infectious Diseases
• Endocrinology

Background:

• Miliary tuberculosis can present with complex endocrine and hematologic complications.
• Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) and severe thrombocytopenia are rare but serious manifestations.

Observation:

• A 74-year-old female patient with miliary tuberculosis presented with moderately severe hyponatremia and very severe thrombocytopenia.
• No other hematologic abnormalities were noted.
• The patient received a treatment regimen including isoniazid, rifampin, ethambutol, prednisone, vincristine, and fluid restriction.

Findings:

• Complete recovery was achieved following the treatment regimen.
• SIADH may have been triggered by decreased intravascular volume due to pulmonary disease or hypoxia, or by ADH-like substances released from the tuberculous lung.
• Thrombocytopenia could be attributed to a toxic effect of infection or activation of idiopathic thrombocytopenic purpura.

Implications:

• This case highlights the diverse clinical presentations of miliary tuberculosis.
• It underscores the importance of considering SIADH and thrombocytopenia in patients with disseminated tuberculosis.
• Prompt and comprehensive treatment can lead to favorable outcomes in complex cases.