Disseminated tuberculosis

Case contributed by Jini P Abraham


High-grade fever for 6 months, aggravated for 2 weeks, associated with chills and rigors. 1 episode of altered sensorium with seizures. Cough for 3 days.

Patient Data

Age: 40 years
Gender: Male

MRI brain revealed sulcal enhancement in bilateral cerebral hemispheres on the post-contrast FLAIR images, suggesting leptomeningitis.


CT chest revealed multiple enlarged mediastinal lymphadenopathy, showing homogenous enhancement in post-contrast image.

Dependant ground-glass opacities and a few tiny nodules in both lungs.

Few subcentimeter supraclavicular lymph nodes.

Visualized upperabdomen revealed an ill-defined non-enhancing area in the left lobe of the liver. Few focal non-enhancing lesions were noted in the right lobe of the liver. Filling defect noted in a segmental branch of the left portal vein.

USG guided liver biopsy was performed. 

Microscopy: Sections from left lobe of liver shows confluent granulomas within hepatic parenchyma surrounded by fibrosis. Granulomas are composed of epitheloid cells and lymphocytes. Hepatocytes shows mild macrovesicular fatty change. Sinusoidal congestions and mild portal inflammation are seen.

Features are suggestive of granulomatous hepatitis.

Case Discussion

Subsequent CSF analysis revealed Mycobacterium tuberculosis. The patient was started on ATT and the patient's condition improved.

Disseminated or miliary tuberculosis is a widespread form of the disease caused by the hematogenous spread of Mycobacterium tuberculosis. Disseminated disease can occur within weeks of primary infection. Abdominal manifestations of tuberculosis are seen in about 11-15% of patients with extra-pulmonary tuberculosis. Structures involved in abdominal tuberculosis are gastrointestinal and genitourinary tracts, liver, spleen, pancreas, gall bladder, peritoneum and lymph nodes. Other common sites of involvement include the cardiovascular, brain, spine, neck and musculoskeletal systems. Tuberculosis affects different organs in different ways. CT and MR imaging can help in the detection and accurate characterization of the disease.

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