An Autopsy Case of Miliary Tuberculosis and Review of Autopsy Cases in Japan

Presented is an autopsy case of a 79 year-old male who died of miliary tuberculosis. The patient was admitted to the University Hospital with an unknown fever and suspicion of leukemia. He expired on the 13th day of hospitalization. Postmortem examination revealed generalized miliary tuberculosis. The diagnosis of tuberculosis was established only after autopsy. Difficulty in diagnosis of miliary tuberculosis is discussed. Also discussed is a probable association of acute interstitial nephritis with chemotherapy or miliary tuberculosis. Leukemoid reaction is thought to be associated with miliary tuberculosis. The present case reminds us that miliary tuberculosis should never be forgotten when treating a patient having a fever of unknown origin. Cases with tuberculosis were compiled from the Annual of Pathological Autopsy Cases in Japan during 1974 through 1981. There were 3,242 cases of tuberculosis (1.4%) out of 235,095 autopsies recorded in the Annual of Pathological Autopsy Cases in Japan during the above 8 years. Of 3,242 cases 618 were miliary tuberculosis. The latter figure indicates 19.0% of all tuberculosis and 0.26% of all autopsies. Although all age groups were not spared, the 7th and 8th decades were more affected than the others. Tuberculosis has markedly declined since the advent of antituberculous antibiotics. But, autopsy cases with tuberculosis have not recently decreased in number. Clearly, increased awareness of the continuing presence of tuberculosis is needed.