Fatal acute miliary tuberculosis complicated by obstructive jaundice, acute pancreatitis, and hemophagocytic lymphohistiocytosis in a 57-year-old immunocompetent female: a case report

BACKGROUND: Miliary tuberculosis occurs in 2% of all patients with tuberculosis when Mycobacterium tuberculosis circulates in the bloodstream, leading to various nonspecific features. Delayed diagnosis and treatment are associated with poor prognosis and outcomes, with complications becoming life-threatening, making management very challenging for clinicians. CASE PRESENTATION: A 57-year-old immunocompetent Pakistani female presented with nonspecific features, and further investigations yielded a diagnosis of miliary tuberculosis, accompanied by several rare complications, including pancreatitis, obstructive jaundice, acute respiratory distress syndrome, disseminated intravascular coagulation, hemophagocytic lymphohistiocytosis syndrome, and liver failure. Management was challenging, and the patient subsequently died owing to further derangement in liver function. CONCLUSION: Miliary tuberculosis may present with nonspecific features and symptoms, and a thorough correlation between clinical examination, radiological findings, and laboratory tests is required to establish the diagnosis. The delayed diagnosis and treatment of miliary tuberculosis majorly affect patient outcomes. The progression of the disease is unpredictable, and several complications, although rare, may occur all at once, emphasizing the importance of multidisciplinary collaboration between specialists. Hemophagocytic lymphohistiocytosis symptoms may overlap with miliary tuberculosis symptoms, and antituberculosis therapy medications are irreplaceable in the treatment of tuberculosis-related hemophagocytic lymphohistiocytosis. Immunocompetence is not a basis for excluding miliary tuberculosis.