CASE REPORT: MILIAR TUBERCULOSIS WITH RADIOLOGICAL FOUND OF CENTROLOBULAR MICRODONS IN IMMUNOSUPRIMED PATIENT
DOI:
https://doi.org/10.56238/arev8n2-122Keywords:
Tuberculosis, Miliary, ImmunosuppressionAbstract
The case of a 73-year-old female patient, immunosuppressed by chronic lymphocytic leukemia treated with chemotherapy, who developed miliary tuberculosis, diagnosed after radiological findings of centrilobular micronodules and histopathological confirmation. The clinical relevance of this report lies in the diagnostic challenge of miliary tuberculosis in immunosuppressed patients, in which clinical presentation and initial examinations may be nonspecific and inconclusive, requiring invasive investigation for confirmation, which may delay therapy and increase morbidity and mortality. The objective is to describe the case, highlighting the importance of a careful diagnostic approach and histopathological confirmation for adequate therapeutic conduction, aiming at reducing morbidity and mortality associated with the disease. The methodology was based on review of medical records, laboratory tests, imaging findings and histopathological analysis. As a result of the study of the patient's case, tomography was performed, which showed diffuse centrilobular micronodules, and the diagnosis was confirmed by histopathology compatible with miliary tuberculosis, allowing the institution of specific treatment. It is concluded that in immunosuppressed patients, miliary tuberculosis may present nonspecific manifestations, and in-depth diagnostic investigation, including invasive methods, is essential for timely therapeutic definition.
Downloads
References
1. Wei X, et al. The clinical features and prognostic factors of miliary tuberculosis in a high tuberculosis burden area. Ann Med. 2024;56(1):2356647. DOI: https://doi.org/10.1080/07853890.2024.2356647
2. Gomes M, Saad Junior R, Stirbulov R. Tuberculose pulmonar: relação entre baciloscopia de escarro e lesões radiológicas. Rev Inst Med Trop Sao Paulo. 2003;45:275-81. DOI: https://doi.org/10.1590/S0036-46652003000500007
3. Sharma SK, Mohan A, Sharma A. Miliary tuberculosis: A new look at an old foe. J Clin Tuberc Other Mycobact Dis. 2016;3:13-27. doi:10.1016/j.jctube.2016.03.003. DOI: https://doi.org/10.1016/j.jctube.2016.03.003
4. Freire PS, et al. Tuberculose miliar: infecção oportunista grave em pacientes com lúpus eritematoso sistêmico juvenil. Rev Bras Reumatol. 2016;56:274-9. DOI: https://doi.org/10.1016/j.rbr.2014.04.007
5. Rabelo IBL, et al. Tuberculose miliar em paciente imunossuprimido: um desafio diagnóstico. Braz J Infect Dis. 2022;26:101994. DOI: https://doi.org/10.1016/j.bjid.2021.101994
6. Obin EH, Tristram D. Tuberculosis overview. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
7. Lemos VS, et al. Tuberculose miliar em paciente imunocompetente: relato de caso. Braz J Health Rev. 2020;3(6):17226-34. DOI: https://doi.org/10.34119/bjhrv3n6-143
8. Kusumaningrum D, et al. Implication of negative GeneXpert Mycobacterium tuberculosis results in suspected tuberculosis patients: a study in Indonesia. J Clin Microbiol. 2024;62(4):e02034-23.
9. Amaya G, et al. Rendimiento del GeneXpert en el diagnóstico de tuberculosis en niños menores de 15 años en Uruguay. Rev Med Uruguay. 2020;36(2):96-101. DOI: https://doi.org/10.29193/RMU.36.2.3
10. Oliveira AP. Comprometimento pulmonar nas leucemias: avaliação por tomografia computadorizada de alta resolução. Rev Bras Hematol Hemoter. 2004;26(2):115-20. DOI: https://doi.org/10.1590/S1516-84842004000200013
