Miliary tuberculosis and haemophagocytic lymphohistiocytosis

Case contributed by Dr Sachintha Hapugoda

Presentation

Chest discomfort and weight loss. Immunosuppressed with a background of haemophagocytic lymphohistiocytosis.

Patient Data

Age: 40 years old
Gender: Male

Extensive widespread lung nodules. No concerning osseous lesion.

Extensive small bilateral pulmonary nodules are seen with areas of air space opacification (mostly to right middle lobe).

There is hepatomegaly and gallbladder wall thickening, consistent with haemophagocytic lymphohistiocytosis.

Overall findings are in keeping with miliary infection (tuberculosis), differential includes metastases.

Day 3 of admission: increased airspace opacification with widespread distribution.

Endotracheal tube and right permacath.

Case Discussion

A case of miliary tuberculosis with imaging features of haemophagocytic lymphohistiocytosis.

This is in the setting of immunosuppression with a known background of haemophagocytic lymphohistiocytosis, and previous travel to the South Pacific Islands.

Sputum was positive for acid-fast bacilli.

The patient passed away after developing multi-organ failure due to disseminated disease.

Case courtesy of Dr. Bradley Wray.

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Case information

rID: 54032
Case created: 20th Jun 2017
Last edited: 26th Jun 2017
Systems: Chest, Haematology
Inclusion in quiz mode: Included

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