-Report on Experiments and Clinical Cases-

Autopsy Cases of Miliary Tuberculosis: Clinicopathologic Features Including Background Factors

Takuma Tajiri¹, Genshu Tate¹, Mutsuki Makino², Hidetaka Akita², Mutsuko Omatsu³, Tetsuji Enosawa¹, Shigeharu Hamatani³, Atsuko Masunaga¹, Toshiaki Kunimura³, Toshiyuki Mitsuya¹ and Toshio Morohoshi⁴

¹Department of Diagnostic Pathology, Showa University Fujigaoka Hospital, Kanagawa
²Department of Diagnostic Pathology, Showa University Hospital, Tokyo
³Department of Diagnostic Pathology, Yokohama Northern Hospital, Kanagawa
⁴First Department of Pathology, Showa University School of Medicine, Tokyo

To assist physicians, especially young physicians, in identifying tuberculosis (TB) infection before the terminal stage, we analyzed 7 cases of numerous tuberculous granulomas in multiple organs and compared clinical and autopsy findings between cases. Patients ranged in age from 41 to 86 years at the time of death. The main chief complaint was fever of unknown origin (3 of 7 cases [43%]). The main underlying conditions were liver cirrhosis (2 of 7 cases [29%]) and chronic renal failure (2 of 7 cases [29%]). Two patients (29%) had been given methylprednisolone pulse therapy for various lung disorders. Active TB was not diagnosed before autopsy in 4 of 7 (57%) patients. Calcified lesions indicative of old TB were present in 4 of 7 (57%) patients. Thus, miliary tuberculosis may represent a re-emergence of latent TB infection in these cases. Various histologic features of nonreactive exudative inflammation were seen, along with granulomas containing Langhans giant cells with or without caseous necrosis in hypervascular organs, such as the lung, liver, and bone marrow. Physicians should be mindful of the possibility of miliary TB when older patients with hepatorenal disease and a history of TB infection have undergone immunosuppressive treatment. Active tuberculous infection can depend on the presence of an underlying disease and immunocompromise.

J Nippon Med Sch 2011; 78: 305-311

Keywords
miliary tuberculosis, latent tuberculosis, autopsy, immunosuppressive therapy

Correspondence to
Takuma Tajiri, MD, Department of Diagnostic Pathology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan
takumatajiri1003@yahoo.co.jp

Received, March 9, 2011
Accepted, August 9, 2011