Abstract
A 71-year-old woman with type 2 diabetes mellitus and hypertension was admitted to our hospital due to physical immobility, a fever and hyperglycemia. No typical finding of miliary tuberculosis was observed on chest computed tomography on this admission. She was first diagnosed with a biliary tract infection according to an elevated C-reactive protein concentration, a liver enzyme test and wall thickening of the gall bladder on abdominal computed tomography and ultrasound, and antibiotics were administered. During two weeks of antibiotic therapy, the C-reactive protein level decreased by quinolone antibiotic therapy, however, her fever and liver dysfunction persisted. A liver and bone marrow biopsy showed Langhans giant cell and epithelioid granuloma without caseous necrosis and miliary tuberculosis was consequently suspected. When she developed acute lung injury on day 22, anti-tuberculous therapy was initiated and her general status and liver dysfunction thereafter rapidly improved.
