title: Clinically unrecognized miliary tuberculosis: an autopsy study.
abstract: BACKGROUND
  Miliary tuberculosis (TB) usually presents with atypical clinical manifestations; thus it is often recognized only at autopsy.
  
  
  OBJECTIVE
  Our objectives were to study the frequency of MT diagnosed at autopsy and determine clinical diagnoses that masked TB, as well as causes of death and comorbidities.
  
  
  METHODS
  Retrospective study of all autopsies performed between 2008 and 2014.
  
  
  METHODS
  Institute of Pathology, Belgrade, Serbia.
  
  
  METHODS
  in subjects where autopsy showed the presence of MT that was not recognized clinically, we recorded the clinical diagnoses (presumed causes of death) as reported in autopsy request forms, as well as actual cause of death and comorbidities as determined at autopsy.
  
  
  METHODS
  Clinically unrecognized MT.
  
  
  RESULTS
  The total number of autopsies in this period was 6206. thirty-five individuals showed clinically unrecognized MT (0.56% of all autopsies, age: 62.2 [17.2] years, M:F=2:3). Common clinical diagnoses masking pulmonary MT were exacerbation of COPD (25%) and pulmonary thromboembolism (25%), with common radiological presentation of diffuse pulmonary infiltrates (56.3%). Dominant clinical diagnoses in patients with generalized MT were adult respiratory distress syndrome, sepsis, gastrointestinal bleeding and meningoencephalitis. Disseminated MT was often associated with secondary anemia or thrombocytopenia (15.8%) and recent surgery (15.8%). Frequent comorbidities included chronic renal failure and malignancies, whereas MT was a dominant cause of death.
  
  
  CONCLUSIONS
  Greater awareness of MT is needed to improve recognition in clinical settings. In particular, MT should be considered in patients with atypical clinical presentation and diffuse pulmonary infiltrates on chest X-ray, particularly if they have chronic renal failure, malignancy, hematological disorders or a history of recent surgery.
  
  
  CONCLUSIONS
  None.
authors.affiliation: Ivana Savic, Faculty of Medicine,, University of Belgrade,, Institute of Pathology, Dr Subotica 1 Belgrade 11000 Serbia, . T: +381 11 3643 409, ivanasavic86@yahoo.com.
authors.forename: Ivana
authors.initials: I
authors.lastname: Savic
authors.forename: Vesna
authors.initials: V
authors.lastname: Trifunovic-Skodric
authors.forename: Dragan
authors.initials: D
authors.lastname: Mitrovic
mesh_terms: D000368:Aged; D001344:Autopsy; D002423:Cause of Death; D057210:Delayed Diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055771:Serbia / Q000453:epidemiology; D014391:Tuberculosis, Miliary / Q000175:diagnosis* / Q000401:mortality