Miliary tuberculosis: an atypical presentation

Miliary tuberculosis (TB) is a severe form of disseminated TB. In developing countries childhood miliary TB is a significant health problem. Pulmonary TB is the most common type of TB in children. Of all TB cases miliary TB accounts for about 1%. We report a case of paediatric miliary TB with acute presentation in a eleven years old female who presented with fever and cough since 3 days and rapid breathing since one day. Clinical examination showed hepatosplenomegaly, on auscultation chest was clear and air entry bilateral equal, chest x-ray was suggestive of miliary shadows suggestive of TB and it was confirmed by HRCT chest. Laboratory studies revealed anaemia and elevated erythrocyte sedimentation rate (ESR). Tuberculin test was negative, gastric lavage for acid-fast bacilli Gene-Xpert was positive for mycobacterium tuberculosis. Fundus examination revealed bilateral small, white sub retinal opacities with the classical appearance of choroidal tubercles. The diagnosis of Miliary TB was confirmed and the patient was started on anti TB therapy.