Tuberculosis, Miliary

Dispersed 2

Step 1: View clinicals

A 17 year old girl presents with a productive cough in a background of fever and fatigability for 9 weeks. She also experienced severe anorexia and lost 10 kg of weight during the same period. She lives with her extended family in a trailer park. There is no history of smoking, or drug abuse. A chest x-ray shows miliary mottling in both lung fields. A tuberculin test is performed and found to be negative.


Step 2: Order all relevant investigations

HIV Serology

Negative.

HRCT Chest

The HRCT demonstrates nodules < 2mm in size randomly distributed along the the lung parenchyma. Bilateral diffuse reticulonodular shadowing is also seen.

Sputum for AFB

Three samples are obtained. All are positive for acid-fast bacilli.

Lumbar Puncture

All indices are within normal parameters.


Step 3: Select appropriate management

Clarithromycin
Antituberculous Therapy
Corticosteroids
Notification


Score: ★★☆