A 43-year-old diabetic man had a productive
cough and high
fever and was admitted to another hospital. His condition did not improve despite treatment with
Cefepime, and he was transferred to our hospital. Chest
X-ray films and CT findings showed pulmonary infiltration and diffuse ground-glass opacities in bilateral lung fields, but disseminated nodules were not identified. Since his bronchial lavage fluid (BALF) was bloody, we suspected diffuse alveolar
hemorrhage due to
vasculitis.
Steroid pulse
therapy was given, and his
fever and chest X-ray findings completely improved. However, 1 week later, he again suffered a high
fever and bloody sputum, and a chest
X-ray film showed granular shadows in bilateral lung fields. He died of
respiratory failure on the 18th hospital day despite treatment and
mechanical ventilation. An autopsy revealed many necrotizing epithelioid
granulomas in both lungs, the liver, the spleen, both kidneys and both adrenal glands. These findings indicated
miliary tuberculosis, and a culture of his sputum and BALF finally revealed mycobacterium tuberculosis. Marked alveolar
hemorrhage and a hyaline membrane were also found in both lungs, but
vasculitis was not recognized in any organ. We report this case, because to the best of our knowledge diffuse alveolar
hemorrhage has not been reported as the primary symptom of
miliary tuberculosis.