[A case of apyretic miliary tuberculosis which was discovered accidentally].

A 78 year-old female was referred to our hospital, because diffuse miliary shadows in bilateral lung fields were discovered during upper G.I. series. She did not complain of fever or display any chest symptoms. Her laboratory data on admission revealed mild hypoxemia and high serum CA 19-9. The transbronchial lung biopsy specimen proved epithelioid cell granulomas. M. tuberculosis was observed on culture from the sputa, urine and bronchoalveolar lavage fluid. She was diagnosed to have miliary tuberculosis, and antituberculous drugs were administered. After the antituberculous therapy, the diffuse miliary shadows on the chest X-ray diminished gradually, and the laboratory data improved. No elevation in the body temperature was seen during the entire clinical course. Though it is known that miliary tuberculosis in elderly patients is often atypical and has mild symptoms, miliary tuberculosis without fever is very rare.