title: Clinical aspects of miliary tuberculosis in Saudi adults.
abstract: OBJECTIVE
  To review all cases of miliary tuberculosis (MT) over a period of 7 years in a Saudi Arabian population, to determine the clinical and laboratory characteristics and diagnostic methods, and to compare our data with others reported in the literature.
  
  
  METHODS
  A retrospective case review.
  
  
  RESULTS
  Of 780 cases of active tuberculosis seen over period of 7 years, 47 (6%) had MT. The majority of the patients were aged over 60 years (68%). The most common symptoms were fever and weight loss. Risk factors were present in 70% of cases, mainly diabetes mellitus, history of prior tuberculosis, chronic liver and renal disease, immunosuppressive drug therapy and malignancy. Miliary pattern on chest radiography was seen in 89%. The most common laboratory abnormalities were anemia (66%), lymphopenia (89%), low albumin (87%), and high alkaline phosphatase (80%). Fiberoptic bronchoscopy was diagnostic in 7/10 (70%), bone marrow examination in 8/11 (73%), and liver biopsy in 14/16 (88%). High alkaline phosphatase and lymphopenia were associated with high yield of liver biopsies and bone marrow examination: 13/14 (93%) and 7/8 (88%), respectively. Death occurred in 10/47 (21%); all of these had radiological evidence of miliary pattern, and 80% had comorbid conditions.
  
  
  CONCLUSIONS
  These data confirm and extend the results of other studies and suggest that MT is a disease of the elderly and immunocompromised, and is associated with high mortality. A high index of suspicion is required for diagnosis.
authors.affiliation: Department of Pulmonary and Infectious Disease, King Fahad National Guard Hospital, Riyadh, Saudi Arabia. jahdali@yahoo.com
authors.forename: H
authors.initials: H
authors.lastname: Al-Jahdali
authors.forename: K
authors.initials: K
authors.lastname: Al-Zahrani
authors.forename: P
authors.initials: P
authors.lastname: Amene
authors.forename: Z
authors.initials: Z
authors.lastname: Memish
authors.forename: A
authors.initials: A
authors.lastname: Al-Shimemeri
authors.forename: M
authors.initials: M
authors.lastname: Moamary
authors.forename: A
authors.initials: A
authors.lastname: Alduhaim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D014391:Tuberculosis, Miliary / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality