Taguchi Hirokazu, Sumitomo Shuji, Oka Hideki, Hara Shigeo, Ohmura Koichiro
Rheumatology, Kobe City Medical Center General Hospital, Kobe, JPN.
Pathology, Kobe City Medical Center General Hospital, Kobe, JPN.
Cureus. 2025 Aug 25;17(8):e90979. doi: 10.7759/cureus.90979. eCollection 2025 Aug.
Miliary tuberculosis (TB), a severe form of TB caused by lymphohematogenous dissemination from a focus, usually presents with systemic symptoms including fever and malaise. Here, we report the case of an 87-year-old woman treated with low-dose prednisolone and methotrexate for polymyalgia rheumatica, incidentally diagnosed with small miliary nodules in her lungs on chest computed tomography without any symptoms. Moreover, the patient reported being full of energy. The acid-fast bacterial culture and polymerase chain reaction test from various sites, including the transbronchial lung biopsy (TBLB) and bronchoalveolar lavage fluid, were negative; however, the histology of the TBLB specimen revealed epithelioid granuloma without acid-fast bacteria. One and a half months later, she was admitted to our hospital with fever and somnolence. The cerebrospinal fluid culture test was positive for and the patient was diagnosed with miliary TB complicated by tuberculous meningitis. This report suggests that although systemic symptoms usually accompany miliary TB, patients can be asymptomatic, and careful follow-up is important when suspected.
粟粒性肺结核是由病灶经淋巴血行播散引起的一种严重肺结核形式，通常表现为发热和不适等全身症状。在此，我们报告一例87岁女性病例，该患者因风湿性多肌痛接受低剂量泼尼松龙和甲氨蝶呤治疗，胸部计算机断层扫描偶然发现肺部有小结节，且无任何症状。此外，患者自述精力充沛。包括经支气管肺活检（TBLB）和支气管肺泡灌洗液在内的多个部位的抗酸细菌培养及聚合酶链反应检测均为阴性；然而，TBLB标本的组织学检查显示有上皮样肉芽肿但无抗酸细菌。一个半月后，她因发热和嗜睡入住我院。脑脊液培养检测结核分枝杆菌呈阳性，患者被诊断为粟粒性肺结核并发结核性脑膜炎。本报告提示，尽管粟粒性肺结核通常伴有全身症状，但患者也可能无症状，疑似病例时仔细随访很重要。
