Miliary tuberculosis: 2 case reportsIn a case series, two men aged 63-68 years were described, who developed miliary tuberculosis during treatment with BCG for high-grade pT1 bladder cancer [dosages not stated].Case 1: A 63-year-old man had a history of high-grade pT1 bladder cancer and treated with two intravesical instillation of BCG and transurethral resection. He presented to the emergency department with chills, sweating and daily fever. The onset of symptoms was after 2 weeks of last initiation of BCG. He received levofloxacin, but no improvement was noted. His physical examination revealed fever and poor general condition. An auscultation showed generalised decreased vesicular breathing sounds and crackles in both lung bases. His blood tests revealed increased levels of creactive protein. Urinalysis showed moderate leukocyturia and hematuria. Chest radiography showed signs of emphysema. Chest CT scan showed severe centrilobular and paraseptal emphysema and innumerable lung micronodules spread over the non-emphysematous lung parenchyma with a random pattern. Based on all these findings, a diagnosis of miliary tuberculosis (TB) secondary to BCG was made. Further, he received isoniazid, rifampicin and ethambutol over a period of 9 months and attained complete remission of symptoms.Case 2: A 68-year-old man had a history of high blood pressure, permanent atrial fibrillation and mild hemophilia A. He has recently diagnosed with high-grade pT1 bladder cancer treated with two intravesical instillation of BCG and transurethral resection. He presented to the emergency department with fever and general malaise. The onset of symptoms was after 10 days of last initiation of BCG. During presentation, his blood tests showed leukocytes 13 400 /mm3 and mild elevated liver function markers. A chest CT scan showed an interstitial pattern consisting of innumerable micronodules a few millimeters in diameter with well-defined contours, distributed over the parenchyma of both lungs. Based on all these findings, a diagnosis of miliary tuberculosis (TB) secondary to BCG was made. Further, he received rifampicin, isoniazid, ethambutol and pyrazinamide over a period of 6 months and attained complete remission of symptoms.
