title: Autopsy cases of miliary tuberculosis: clinicopathologic features including background factors.
abstract: To assist physicians, especially young physicians, in identifying tuberculosis (TB) infection before the terminal stage, we analyzed 7 cases of numerous tuberculous granulomas in multiple organs and compared clinical and autopsy findings between cases. Patients ranged in age from 41 to 86 years at the time of death. The main chief complaint was fever of unknown origin (3 of 7 cases [43%]). The main underlying conditions were liver cirrhosis (2 of 7 cases [29%]) and chronic renal failure (2 of 7 cases [29%]). Two patients (29%) had been given methylprednisolone pulse therapy for various lung disorders. Active TB was not diagnosed before autopsy in 4 of 7 (57%) patients. Calcified lesions indicative of old TB were present in 4 of 7 (57%) patients. Thus, miliary tuberculosis may represent a re-emergence of latent TB infection in these cases. Various histologic features of nonreactive exudative inflammation were seen, along with granulomas containing Langhans giant cells with or without caseous necrosis in hypervascular organs, such as the lung, liver, and bone marrow. Physicians should be mindful of the possibility of miliary TB when older patients with hepatorenal disease and a history of TB infection have undergone immunosuppressive treatment. Active tuberculous infection can depend on the presence of an underlying disease and immunocompromise.
authors: Department of Diagnostic Pathology, Showa University Fujigaoka Hospital, Kanagawa, Japan. takumatajiri1003@yahoo.co.jp
authors: Takuma
authors: T
authors: Tajiri
authors: Genshu
authors: G
authors: Tate
authors: Mutsuki
authors: M
authors: Makino
authors: Hidetaka
authors: H
authors: Akita
authors: Mutsuko
authors: M
authors: Omatsu
authors: Tetsuji
authors: T
authors: Enosawa
authors: Shigeharu
authors: S
authors: Hamatani
authors: Atsuko
authors: A
authors: Masunaga
authors: Toshiaki
authors: T
authors: Kunimura
authors: Toshiyuki
authors: T
authors: Mitsuya
authors: Toshio
authors: T
authors: Morohoshi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007676:Kidney Failure, Chronic; D008103:Liver Cirrhosis; D008171:Lung Diseases; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D014391:Tuberculosis, Miliary / Q000382:microbiology / Q000473:pathology*
chemical_list: D007166:Immunosuppressive Agents; D008775:Methylprednisolone