title: Miliary tuberculosis presenting with rigors and developing unusual cutaneous manifestations.
abstract: We report a case of miliary tuberculosis presenting with high fevers and rigors. While undergoing evaluation, the patient developed a diffuse, erythematous, maculopapular eruption coalescing to form erythematous plaques involving the abdomen, trunk, and proximal extremities. Biopsies of the lesions were smear- and culture-negative for Mycobacterium tuberculosis. Rigors are an unusual presenting symptom of miliary tuberculosis and have only been reported three times in the (post-antibiotic era) literature. Chills have been reported to occur 28% of the time. This symptom can be confusing to the practitioner, leading to delay in diagnosis. The skin lesions were most consistent with a lichenoid tuberculid eruption. The patient had a negative purified protein derivative and non-reactive anergy panel, and the lesions involved only the cutis and healed without scarring. The patient had a dramatic response to antituberculous therapy, with resolution of the fever within 2 days and resolution of the rash within 2 weeks.
authors.affiliation: Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas 78234-6200, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Lowry
authors.forename: K T
authors.initials: KT
authors.lastname: Stephan
authors.forename: C E
authors.initials: CE
authors.lastname: Davis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005076:Exanthema / Q000209:etiology; D006801:Humans; D008297:Male; D012867:Skin / Q000473:pathology; D012871:Skin Diseases / Q000209:etiology*; D014391:Tuberculosis, Miliary / Q000150:complications* / Q000175:diagnosis