Assaf Ahed, Khaddour Suleiman, Karaja Saja, Borghol William, Almohammad Haya, Wassel Mario, Alkeshk Kinan, Shammat Akram
Faculty of Medicine, Hama University, Hama, Hama, Syria.
Faculty of Medicine, Tishreen University, Lattakia, Syria.
J Med Case Rep. 2025 Sep 29;19(1):466. doi: 10.1186/s13256-025-05558-8.
Miliary tuberculosis occurs in 2% of all patients with tuberculosis when Mycobacterium tuberculosis circulates in the bloodstream, leading to various nonspecific features. Delayed diagnosis and treatment are associated with poor prognosis and outcomes, with complications becoming life-threatening, making management very challenging for clinicians.
A 57-year-old immunocompetent Pakistani female presented with nonspecific features, and further investigations yielded a diagnosis of miliary tuberculosis, accompanied by several rare complications, including pancreatitis, obstructive jaundice, acute respiratory distress syndrome, disseminated intravascular coagulation, hemophagocytic lymphohistiocytosis syndrome, and liver failure. Management was challenging, and the patient subsequently died owing to further derangement in liver function.
Miliary tuberculosis may present with nonspecific features and symptoms, and a thorough correlation between clinical examination, radiological findings, and laboratory tests is required to establish the diagnosis. The delayed diagnosis and treatment of miliary tuberculosis majorly affect patient outcomes. The progression of the disease is unpredictable, and several complications, although rare, may occur all at once, emphasizing the importance of multidisciplinary collaboration between specialists. Hemophagocytic lymphohistiocytosis symptoms may overlap with miliary tuberculosis symptoms, and antituberculosis therapy medications are irreplaceable in the treatment of tuberculosis-related hemophagocytic lymphohistiocytosis. Immunocompetence is not a basis for excluding miliary tuberculosis.
当结核分枝杆菌在血液中循环时，粟粒性肺结核在所有肺结核患者中占2%，会导致各种非特异性特征。诊断和治疗延迟与预后不良及结局不佳相关，并发症会危及生命，这给临床医生的管理带来极大挑战。
一名57岁免疫功能正常的巴基斯坦女性出现非特异性症状，进一步检查确诊为粟粒性肺结核，并伴有多种罕见并发症，包括胰腺炎、梗阻性黄疸、急性呼吸窘迫综合征、弥散性血管内凝血、噬血细胞性淋巴组织细胞增生症综合征和肝功能衰竭。治疗颇具挑战性，患者随后因肝功能进一步紊乱而死亡。
粟粒性肺结核可能表现为非特异性症状，需要临床检查、影像学检查结果和实验室检查之间进行全面关联以确立诊断。粟粒性肺结核的诊断和治疗延迟严重影响患者结局。疾病进展不可预测，尽管罕见，但可能会同时出现多种并发症，这凸显了专科医生之间多学科协作的重要性。噬血细胞性淋巴组织细胞增生症症状可能与粟粒性肺结核症状重叠，抗结核治疗药物在治疗结核相关噬血细胞性淋巴组织细胞增生症中不可替代。免疫功能正常并非排除粟粒性肺结核的依据。
