Abstract
The patient was an 84-year-old male who was treated for hypertension in another hospital. In addition to general malaise and anorexia lasting for about a month, the patient had a high fever, which prompted the referral to our department. Chest x-ray and chest CT scan upon admission revealed ground glass appearance and diffuse granular infiltration in both lung fields. We suspected a pulmonary infection, such as miliary tuberculosis, and an anti-TB regimen and ciprofloxacin CPFX were administered. Mycobacterium tuberculosis in the sputum, gastric juices, and urine were detected several days later by bacteriological tests, confirmed the diagnosis of miliary tuberculosis. On the third day of hospitalization, hypoxemia worsened and developed into acute respiratory distress syndrome ARDS; the patient was immediately placed on a ventilator and corticosteroids were administered. The patient responded well to these treatments, and was successfully extubated 6 days later. The patient had slow but steady, uneventful recovery after extubation, and he was discharged home on hospital day 83. Review of literature indicates an extremely poor prognosis of miliary tuberculosis developing to ARDS, with mortality of 70-80. We believe that this patient survived due the to early introduction of anti-TB drug therapy, even before the diagnosis was confirmed. When an elderly individual develops a high fever of unknown origin with pulmonary infiltrate, a differential diagnosis must be made with miliary tuberculosis in mind and anti-TB drug therapy should be initiated even before the diagnosis is confirmed.
