[A case of arteria cerebri aneurysm, sepsis, and miliary lung infiltrates in a 32-year-old woman].
BACKGROUND
Miliary tuberculosis is a rare manifestation of tuberculosis with a high mortality rate. Diagnosis may easily be missed when severe neurologic symptoms are the first clinical manifestation. A typical case of miliary tuberculosis is reported, with special regard to the problems of diagnostic work-up. The need for an early empirical therapy for suspected military tuberculosis is emphasized in particular.


METHODS
A 32-year-old Moroccan woman was admitted to the hospital with aphasia and a hemiparesis due to an intracerebral hemorrhage caused by a ruptured septic A. cerebri media aneurysm. Despite intensive work-up no septic focus could be found. Chest radiograph and computerized tomography (CT) showed miliary consolidations in the lungs. Skin testing (Tuberkulin Behring GT5) and smears for acid-fast bacilli and polymerase chain reaction (PCR) for tuberculosis of bronchoalveolar lavage (BAL) were negative. A four-drug antituberculous regimen (rifampicin [RMP], isoniazid [INH], pyrazinamide [PZA], ethambutol [EMB]) was initiated, and resulted in normalization of temperature, blood pressure, and C-reactive protein. Subsequently, cultures of BAL yielded Mycobacterium tuberculosis. The patient was discharged, a two-drug regimen was conducted (RMP, INH) after 2 months. Follow-up of the patient showed a significant improvement of the miliary lung consolidations after 5 months in CT of the lung. Only minor neurologic symptoms persisted after cessation of the therapy.


CONCLUSIONS
In developed countries, miliary tuberculosis is a very rare cause of septic infiltrative lung disease. However, due to the nonspecific nature of the presentation and despite improved diagnostic techniques, a high clinical suspicion is essential for successful treatment.
Manka
Robert
R
Medizinische Klinik und Poliklinik II, Universitätsklinikum, Bonn. robert.manka@ukb.uni-bonn.de
Lentini
Silvia
S
Manka
Christoph
C
Lüderitz
Berndt
B
Tasci
Selçuk
S
D000328:Adult; D017542:Aneurysm, Ruptured / Q000150:complications*; D002536:Cerebral Arteries; D002543:Cerebral Hemorrhage / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications*; D013902:Radiography, Thoracic; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014391:Tuberculosis, Miliary / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy