Abstract
A 66-year-old man, who had been undergoing hemodialysis for 10 months, was admitted because of fever of unknown origin (FUO) and consciousness disorder. A chest roentgenogram on admission revealed diffuse illdefined or acinar shadows throughout both lungs. On the patient's 3rd hospital day, these shadows had become confluent and nodular shadows were present. Laboratory studies suggested the possibility of DIC, hepatic failure and respiratory failure. An electroencephalogram showed slow waves. The tentative diagnosis was miliary tuberculosis. Antitubercular agents were started on the 3 rd hospital day. The diagnosis of miliary tuberculosis was confirmed by pathological examination of a bone marrow aspirate. Despite the antitubercular therapy, the patient's respiratory failure and hepatic failure progressed, and he died on the 41 st hospital day. The association of miliary tuberculosis with multiple organ failure appears to be rare. This case, however, shows that an attempt to treat with antitubercular agents, i.e., so-called “therapeutic diagnosis”, is necessary for the antibiotic-resistant FUO in dialysis patients.
