A 33-year-old male entered our hospital complaining of fever. He had a 12-year history of systemic lupus erythematosus for which he was treated with oral prednisolone.
The physical examination gave negative results except for erythematous lesions of the fingertips. Chest X-ray films revealed clear lung fields. Result of an extensive work-up for his fever was negative. Smears of sputum, urine, gastric juice and bone marrow were negative for acid-fast bacilli. Peritoneoscopy was performed because of the ambiguous result of therapeutic trial with antituberculosis drugs. Peritoneoscopy revealed numerous small white spots on the liver surface and biopsy specimen showed many epithelioid granulomas.
These results allowed a definitive diagnosis of miliary tuberculosis when interpreted in conjunction with other clinical features. His clinical symptoms improved rapidly by replacement of antituberculosis drugs. Peritoneoscopy is a useful diagnostic method in prolonged unexplained fevers.
