Arita K, Daido K, Ejima T, Hirata T, Fujiwara M
Hiroshima Red Cross Hospital, Japan.
Kekkaku. 1993 Oct;68(10):645-51.
It is reported not only that the incidence of active tuberculosis has not decreased but also that the cases of active tuberculosis who had been diagnosed at autopsy for the first time may have increased. The background factors and clinical courses of 13 cases of active tuberculosis whom we could not diagnose as tuberculosis until autopsy were investigated. According to the autopsy reports, the three fourths of the cases had active tuberculosis lesions in several organs as miliary tuberculosis. All of the cases were treated in serious condition of liver cirrhosis, leukemia, and other malignant diseases. Although fever of unknown origin was an important symptom, it was difficult to make a correct diagnosis because the fever was thought to be originated not from active tuberculosis but from the underlying diseases themselves. It was also difficult to diagnose from chest x-ray findings unless tuberculosis was suspected clinically. The education about tuberculosis should be held repeatedly. And we should try to think from different direction for the strange and unexpected clinical features of the patients with liver cirrhosis, leukemia, and other malignant diseases.