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Lee, Cho, Cho, Son, Choi, Na, and Kwon: A Case of Miliary Tuberculosis Misdiagnosed as Pneumonia and ARDS Due to the Transient Improvement after Intravenous Injection of Levofloxacin
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 66(3): 236-240.

Published online: 31 March 2009

DOI: https://doi.org/10.4046/trd.2009.66.3.236

A Case of Miliary Tuberculosis Misdiagnosed as Pneumonia and ARDS Due to the Transient Improvement after Intravenous Injection of Levofloxacin

Go Eun Lee, M.D.1, Young Jun Cho, M.D.2, Hyun Min Cho, M.D.3, Ji Woong Son, M.D.1, Eu Gene Choi, M.D.1, Moon Jun Na, M.D.1, Sun Jung Kwon, M.D.1

1Division of Pulmonology, Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea.

2Department of Diagnostic Radiology, Konyang University College of Medicine, Daejon, Korea.

3Department of Diagnostic Chest Surgery, Konyang University College of Medicine, Daejon, Korea.

Address for correspondence: Sun Jung Kwon, M.D. Department of Internal Medicine, Konyang University Hospital, 685, Kasuwon-dong, Seo-gu, Daejeon 302-718, Korea. Phone: 82-42-600-8820, Fax: 82-42-600-9090, sjoongkwon@hanmail.net

Received 1 February 2009       Accepted 6 March 2009

Copyright©2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Miliary tuberculosis is quite a rare but serious cause of acute respiratory distress syndrome (ARDS). Therefore, the early detection of military tuberculosis as the underlying cause of ARDS is very important for the prognosis and survival of the patient. We report a case of military tuberculosis mimicking ARDS. A female patient was admitted due to repeated fever and dyspnea. The initial chest CT scan showed diffuse ground glass opacity, without a miliary pattern. The case was considered to be ARDS caused by pneumonia. She showed improvement after being treated with levofloxacin. However, she was re-admitted with fever seven days after discharge. The follow up chest CT scan showed micronodules in both lungs. An open lung biopsy confirmed the diagnosis of military tuberculosis.

Keywords: Miliary tuberculosis, Levofloxacin, Acute respiratory distress syndrome

Figures and Tables

Figure 1
At first admission. (A) Chest PA showed diffuse haziness on both entire lung fields in the fifth day of first admission. (B) Chest CT scan showed diffuse ground glass opacity (GGO), consolidation and multiple nodular lesions in both lungs. (C) After the antibiotics therapy, chest PA showed that haziness on both lungs improved in the 18th day of admission.
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Figure 2
(A) At second admission, high resolution computed tomography (HRCT) showed numerous micronodules and ground glass opacity (GGO) in both lungs. (B) Follow up chest HRCT, 3 months later since the patient took anti-tuberculosis medications, numerous nodules and GGO were disappeared in both lungs.
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Figure 3
(A) H&E stain in the lung tissue of the right upper lung obtained by open lung biopsy using video-assisted thoracic surgery (VATS) showed chronic granulomatous inflammation with necrosis (×200). (B) H&E stain showed more detail figures of that (×400). (C) A few acid-fast bacilli were seen on Ziehl-Neelsen stain (×400).
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