Miliary Tuberculosis With Gastrointestinal Involvement in a Young Undocumented Immigrant: A Case Report

Miliary tuberculosis is a severe form of disseminated Mycobacterium tuberculosis infection resulting from hematogenous spread of the organism. It is characterized by numerous small nodular lesions throughout the lungs and other organs and can involve multiple systems, including the gastrointestinal tract. The condition is associated with high morbidity and mortality, particularly when diagnosis and treatment are delayed. This case report describes a 31-year-old male who presented to Chino Valley Medical Center on November 11, 2025, with a five-month history of progressive weight loss, intractable vomiting, fatigue, and chronic productive cough. On admission, he was severely cachectic and reported an inability to tolerate food for over two weeks. Imaging and laboratory evaluation revealed disseminated tuberculosis with a miliary pattern on chest imaging and profound malnutrition. CT imaging of the abdomen without contrast revealed multiple dilated proximal small bowel loops with a transition point in the distal ileum, consistent with small bowel obstruction. Sputum cultures later grew extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli . While this organism is an uncommon cause of primary pneumonia, the finding raised concern for secondary infection or possible aspiration in the setting of severe illness and prolonged hospitalization. Anti-tuberculosis therapy with RIPE (rifampin, isoniazid, pyrazinamide, and ethambutol) was initiated; given severe vomiting and suspected bowel obstruction, the feasibility of oral administration was considered, and the patient was placed in airborne isolation, alongside total parenteral nutrition (TPN), vasopressor support, and broad-spectrum antibiotics. Despite aggressive multidisciplinary care, the patient's condition deteriorated rapidly. He developed supraventricular tachycardia, electrolyte abnormalities, respiratory failure, and multi-organ dysfunction. Resuscitative efforts were unsuccessful, and the patient was pronounced deceased on November 16, 2025. This case highlights the devastating consequences of delayed diagnosis and management of extrapulmonary and miliary tuberculosis, particularly in the context of gastrointestinal involvement and malnutrition. It also underscores the impact of social determinants of health on disease progression and access to care in undocumented immigrant populations.