Potentially fatal form of disseminated disease due to the hematogenous spread of tubercle bacilli to the lungs and other organs
Results in the formation of millet seed-sized tuberculous foci
Disseminated tuberculosis is defined as the simultaneous involvement of at least two non-contiguous organ sites of the body or infection of the blood, bone marrow, or liver
Gross examination- small, punctate, gray to reddish-brown, rounded lesions of the more or less uniform size seen in the lungs and various other organs
Microscopic- each focus represents a typical tubercle with caseous necrosis in the center having tubercle bacilli surrounded by typical Langhans type giant cells, epithelioid cells, lymphocytes, and fibrocytes
Symptoms
Acute miliary TB
Seen under 40 years of age
Evening rise of temperature and night sweats of 1-2 weeks duration
Patient can have early morning fever spikes
Dry cough with scanty sputum
Dyspnea
Hemoptysis (sometimes)
Cryptic miliary TB
Occurs primarily in patients over 60 years of age
General debility is the dominant clinical feature which mimicks metastatic carcinoma
The patients have a normal chest radiograph and negative skin tuberculin test, causing a delay in diagnosis
Fever
Generalized weakness
Weight loss
Cough
Physical exam
Hepatomegaly
Splenomegaly
Lymphadenopathy
Diagnosis
Lab tests
The most common hematological abnormality encountered in miliary TB is anemia of chronic disease.
Elevated acute phase reactants in the form of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are frequently encountered
CXR
Shows typical miliary mottling
i.e., homogenously distributed discrete uniform size (1 to 2 mm) millet-shaped lesions in all lung zones
This is the hallmark for diagnosis of miliary TB
TST
Shows anergy in miliary TB (absence of normal immune repsonse)
It can become positive during antituberculosis therapy
Biopsy specimen
Shows granulomatous inflammation with central caseation, with or without tubercle bacilli
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