Clinical Analysis of Miliary Tuberculosis Patients in Our Tertiary Hospital

Objective: To investigate the clinical characteristics of miliary tuberculosis experienced in our tertiary hospital without a tuberculosis isolation room. Materials and Methods: We obtained a definite diagnosis of tuberculosis for 72 patients in our tertiary hospital between January 2010 and September 2016. There were six patients (8.3%) who were diagnosed with miliary tuberculosis following the isolation of Mycobacterium tuberculosis from several organs, and we analyzed the clinical findings. Results: The average age of the six patients with miliary tuberculosis was 74 years old (3 males and 3 females). All patients had underlying diseases and immunosuppressive treatment was performed for three patients. The detection methods were based on clinical symptoms such as high fever in all patients. Concerning the laboratory findings, three patients showed a negative or indeterminate response for interferon-gamma release assays (IGRAs). Bronchoscopic examinations were performed for five of six patients soon after admission and a definite diagnosis was obtained. Although treatment according to the American Thoracic Society (ATS) guidelines was performed for all patients, three of the six died due to complications or worsening of miliary tuberculosis. Conclusions: Patients with miliary tuberculosis experienced in a tertiary hospital were frequently detected among patients receiving immunosuppressive treatment for a long time. Because these patients showed a rapid progressive clinical course, it is thought to be important to perform bronchoscopic examination proactively for patients suspected of miliary tuberculosis on radiological findings to make an appropriate early diagnosis and start treatment.