TB, or not TB?

A 48-year-old man presented with complaints of intermittent fever, dry cough, breathlessness and significant weight loss for 1 month. He also gave a history of increased urinary frequency and intermittent painless haematuria. Examination revealed bilateral cervical and axillary lymphadenopathy (figure 1A). Auscultation revealed fine inspiratory crepitations in bilateral lung fields. Chest X-ray was suggestive of diffuse involvement, illustrating miliary pattern in bilateral lung fields (figure 1B). Urine examination showed numerous red blood cells. Contrast-enhanced CT of kidney, ureter and bladder suggested a thickened bladder wall (figure 1C). A possibility of disseminated tuberculosis was considered and …