Tuberc Respir Dis.  2009 Mar;66(3):236-240. 10.4046/trd.2009.66.3.236.

A Case of Miliary Tuberculosis Misdiagnosed as Pneumonia and ARDS Due to the Transient Improvement after Intravenous Injection of Levofloxacin

• Lee GE
• Cho YJ
• Cho HM
• Son JW
• Choi EG
• Na MJ
• Kwon SJ

• KMID: 1846387
• DOI: http://doi.org/10.4046/trd.2009.66.3.236

Abstract

Miliary tuberculosis is quite a rare but serious cause of acute respiratory distress syndrome (ARDS). Therefore, the early detection of military tuberculosis as the underlying cause of ARDS is very important for the prognosis and survival of the patient. We report a case of military tuberculosis mimicking ARDS. A female patient was admitted due to repeated fever and dyspnea. The initial chest CT scan showed diffuse ground glass opacity, without a miliary pattern. The case was considered to be ARDS caused by pneumonia. She showed improvement after being treated with levofloxacin. However, she was re-admitted with fever seven days after discharge. The follow up chest CT scan showed micronodules in both lungs. An open lung biopsy confirmed the diagnosis of military tuberculosis.

Keyword

Miliary tuberculosis; Levofloxacin; Acute respiratory distress syndrome

MeSH Terms

Biopsy
Dyspnea
Female
Fever
Follow-Up Studies
Glass
Humans
Injections, Intravenous
Lung
Military Personnel
Ofloxacin
Pneumonia
Prognosis
Respiratory Distress Syndrome, Adult
Thorax
Tuberculosis
Tuberculosis, Miliary
Ofloxacin

Figure

• 

  Figure 1 At first admission. (A) Chest PA showed diffuse haziness on both entire lung fields in the fifth day of first admission. (B) Chest CT scan showed diffuse ground glass opacity (GGO), consolidation and multiple nodular lesions in both lungs. (C) After the antibiotics therapy, chest PA showed that haziness on both lungs improved in the 18th day of admission.

• 

  Figure 2 (A) At second admission, high resolution computed tomography (HRCT) showed numerous micronodules and ground glass opacity (GGO) in both lungs. (B) Follow up chest HRCT, 3 months later since the patient took anti-tuberculosis medications, numerous nodules and GGO were disappeared in both lungs.

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  Figure 3 (A) H&E stain in the lung tissue of the right upper lung obtained by open lung biopsy using video-assisted thoracic surgery (VATS) showed chronic granulomatous inflammation with necrosis (×200). (B) H&E stain showed more detail figures of that (×400). (C) A few acid-fast bacilli were seen on Ziehl-Neelsen stain (×400).

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