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Positive TB, small calcification in lung, intensive abdominal surgery. Now have fever, sweats. Miliary TB?

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Pediatrician, Infectious Diseases
Practicing since : 2005
Answered : 1528 Questions

I am a 52 y/o female, and 11 years ago I had a positive TB skin test. At the time, I worked in the ophthalmology clinic at a well-respected teaching hospital in Tennessee. The test was followed up with a chest x-ray which showed a small calcification in one lung. I was started on TB treatment which was stopped after 5 months. I had started the treatment two months after intensive abdominal surgery and the doctor felt the treatment was to much for my system. I have been taking oral hydrocortisone for the past six years as a result of adrenal insufficiency due to presence and/or partial surgical removal of a non-functioning pituitary tumor. My immune system has become more suppressed the last few years - I have had the shingles twice and Herpangina (Hand,Foot & Mouth disease) a minimum of 6 times during the last two and 1/2 years. During the last 3-4 months, I have had a recurring low fever, tiredness, sweats (more than usual) and tender cervical lymph nodes. Is miliary TB a possibility?

Sandy in TN
Posted Mon, 7 May 2012 in General Health
Answered by Dr. Hema Yadav 46 minutes later

Thanks for posting your query.

Miliary Tuberculosis may present as acute, sub-acute and chronic forms.

The acute form commonly presents as multi-organ dysfunction.

The sub-acute and more likely chronic form, can present as features similar to your symptoms like night sweats, low grade or no fever, and single organ involvement too.

So yes, Miliary Tuberculosis is a possibility especially in an immuno-compromised condition like yours, and with prolonged intake of steroids.

Kindly consult your doctor to confirm the diagnosis by appropriate investigations like lymph node FNAC(Fine Needle Aspiration Cytology) or imaging studies like high resolution CT (computerized Tomography) scan, TB-PCR(Tuberculosis Polymerase Chain Reaction) test etc.

The skin test may not be reliable since you are on steroids. If detected, early treatment would be easier and risk of complications are less.

Please rule out any ophthalmic complications of steroids like glaucoma or cataract as they frequently cause such low vision.

Hope I have answered your query. Please accept my answer in case you do not have further queries.

Above answer was peer-reviewed by
Follow-up: Positive TB, small calcification in lung, intensive abdominal surgery. Now have fever, sweats. Miliary TB? 9 hours later

Thank you so very much for answering my question! I don't want to waste my PCP's office time with an "I saw this on the internet and think I have it" disease (which I'm certain is a huge pet peeve of your profession!), but I do want to prevent any illness from progressing further . I was originally researching the tender lymph nodes in my neck since the symptom has hung around for some time now, and miliary TB seemed the most logical answer. I have an absolutely fantastic PCP who has filled in serious care gaps left by my original endocrinologist whom I have replaced (alas, another specialist because of the pit tumor). She has me taking extra calcium and vitamin C, plus bone density testing. Also, after a 3-month period of weekly doses of Vitamin D2 of 50,000 units following low results from blood work, I am now on that same dosage, but once a month. Unfortunately, taking the one steroid requires the use of multiple other drugs for simple body maintenance. Thus, the Celexa for steroid-induced depression!

I currently see a neuro-ophthalmologist due to the tumor (visual fields, corneal mapping, etc) and also a retinologist a I have had PVD (Posterior Vitreous Detachment) in each eye due to the severe astigmatisms. There are no signs of cataracts although optic nerves are pale. My vision slightly improved for approximately two yearly exams, but the last three annuals by an optometrist warranted an increase in corrective Rx without the ability for 20/20 correction, even in the office.

Obviously, I test positive on the typical TB skin test. Just two last questions: 1) Is TB-PCR a blood test, and 2) I meant to ask this in my initial question, but since it is a posiibility that it could be chronic MTb, can it present with no cough?

Yes/no answers are fine. Again, I thank you for your time spent with me!

Answered by Dr. Hema Yadav 29 minutes later
Thanks for the follow up.
Its my pleasure to be of any help to you.
1.Yes Tb Pcr ( polymerase chain reaction ) to detect any bacterial protein in body is a blood test.For the patients its like getting any other blood test done.
2 Yes miliary Tuberculosis both subacute and chronic may present without any cough depending upon the organ involved.
Hope I have answered your query.
Above answer was peer-reviewed by
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