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Intestinal perforation due to miliary tuberculosis in a patient with myasthenia gravis
  1. Ahmed Ashraf Morgan1,
  2. Adil Mahmood1,
  3. Georgina K Russell2 and
  4. Onn Min Kon1
  1. 1Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
  2. 2Chest & Allergy Clinic, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Ahmed Ashraf Morgan; ahmed.morgan{at}


A man in his early 70s presented to the emergency department with a fall, following a history of fatigue and malodorous urine. On presentation, he was feverish, tachycardic and confused and was treated for presumed urinary sepsis. A chest radiograph showed increased opacification in the left upper lobe with calcification. CT imaging and bronchoalveolar lavage demonstrated miliary tuberculosis infection. His background included myasthenia gravis, which led to challenges in selecting appropriate antituberculosis treatment. During his stay, he developed sudden-onset abdominal pain due to intestinal perforation. He subsequently deteriorated and underwent multiple interventions, including a Hartmann’s procedure and ileocaecal resection. Histological examination of his sigmoid colon revealed abundant acid-fast bacilli. Unfortunately, the patient died due to multiorgan failure in the context of several complications. This case highlights intestinal perforation as a rare complication of miliary tuberculosis and emphasises the importance of being vigilant for this potential complication.

  • Tuberculosis
  • TB and other respiratory infections
  • Gastrointestinal surgery
  • Unwanted effects / adverse reactions
  • Neuromuscular disease

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  • Contributors The care of the patient and selection for the case report was led by GKR and OMK. All authors were involved in care during the patient’s hospital admission. All authors were also involved in writing of the report, with the initial draft written by AAM and revised by AM with further input and revision from GKR and OMK. Images were identified by GKR and OMK and supplied by the relevant clinicians.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.