The patient is a 43-year-old African American male with a past medical history of hypertension, hyperlipidemia, and chronic low back pain who presented to the ER for worsening dyspnea and a 30-lb weight loss over the past 3 months. He also reported a nonproductive cough over this period of time as well as an eruption of small ~1cm flesh-colored nodules on his extremities and trunk. He denied any fevers, chills, or night sweats. In the ER, he had a chest x-ray performed (Figure 1) which showed diffuse centrilobular nodules visualized throughout the lung fields in a miliary pattern. He subsequently had a CT Thorax (Figure 2) performed which showed innumerable miliary nodules and extensive mediastinal and hilar lymphadenopathy. There was suspicion for miliary tuberculosis (TB), and the patient was admitted and placed on airborne precautions. He was also found to be hypercalcemic with calcium of 11.9 mg/dL (normal range 8.5-10.2 mg/ dL) on admission, which improved with IV fluids.
Valentino, MD, PhD, Michael A.
"TB, or not TB?,"
The Medicine Forum:
Vol. 15, Article 25.
Available at: http://jdc.jefferson.edu/tmf/vol15/iss1/25