Diffuse miliary nodules in the bronchial mucosa observed by bronchoscopy: sarcoidosis or tuberculosis?

BACKGROUND AND AIMS: Miliary tuberculosis is a form of tuberculosis that is characterized by a wide dissemination into lung fields. So far, no report has shown a miliary tuberculosis case where diffuse miliary nodules can be observed in airways by bronchoscopy. Here we reported a case of military tuberculosis that can easily be misdiagnosed as sarcoidosis.

METHODS: Report of one case.

RESULTS: Bronchoscopy showed the presence of diffuse miliary nodules in the mucosa of bilateral bronchi. Pathological examination revealed non-caseating necrotic granuloma. Mycobacterium tuberculosis was not detected. Our case was extremely difficult to differentiate sarcoidosis from tuberculosis. With patient's safety in mind, we finally administered anti-tuberculosis therapy and obtained satisfactory results.

CONCLUSION: To our knowledge, this is the first report of a miliary tuberculosis case where diffuse miliary nodules were observed by bronchoscopy. Therefore, when diffused miliary nodules are observed during bronchoscopy, all of the patient's test results should be thoroughly analyzed to rule out miliary tuberculosis. If the diagnosis is very difficult, anti-tuberculosis therapy should be considered first to ensure patient safety.