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Surprising pathological and clinical manifestations of miliary tuberculosis
  1. Kamonkiat Wirunsawanya1,
  2. Dennis Thomas Bolger Jr1,2
  1. 1Department of Medicine, University of Hawaii, Honolulu, Hawaii, USA
  2. 2Hospitalist Program, Queen’s Medical Center, Honolulu, Hawaii, USA
  1. Correspondence to Dr Dennis Thomas Bolger Jr, dbolger{at}


We report a surprising pathological finding of miliary tuberculosis (TB) in a 49-year-old Chuukese, immunocompetent woman who was initially admitted to the hospital for a 1-month duration of chronic abdominal pain and intermittent fevers. Her clinical symptoms did not improve despite treatment with vancomycin and piperacillin–tazobactam. Based on the primary abdominal CT findings suggesting advanced ovarian cancer with omental metastatic disease, further workup with omental core biopsy was performed and demonstrated acute neutrophilic necrosis without malignant cells or granulomata. Within the omental tissue, however, many organisms stained positive for acid-fast bacilli despite lack of typical granulomata. The diagnosis of genitourinary TB was confirmed by urine Mycobacterium tuberculosis/rifampin automated molecular rapid nucleic acid amplification test. The chest CT showed a millet seed pattern of infiltration which is a hallmark for miliary TB. After initiation of multidrug TB therapy, her fever and abdominal pain drastically improved.

  • tuberculosis
  • gynecological cancer
  • urinary tract infections
  • infection (gastroenterology)
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  • Contributors KW wrote the manuscript under the guidance of DTBJ who edited and revised the manuscript. Both authors cared for the patient and determined the education areas in which to focus.

  • 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.

  • Competing interests None declared.

  • Patient consent Obtained.

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

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