Case report: miliary tuberculosis clinical presentation and diagnostic approach in an immunosuppressed patient.

Abstract

Introduction: Miliary tuberculosis is a rare but serious form of tuberculosis resulting from the dissemination of Mycobacterium tuberculosis from a pulmonary or extrapulmonary focus. It is characterized by the presence of multiple granulomatous lesions in any organ and is more frequent in immunosuppressed patients. The pathogenesis involves lymphatic and hematogenous dissemination of the bacilli, which embolize into the vascular beds of various organs. Diagnosis is often complicated due to the nonspecific nature of the symptoms and the need for specialized studies. Case Report: A 32-year-old female patient with a history of seronegative spondyloarthropathy treated with immunomodulators presented with clinical manifestations of abdominal pain, diarrhea, and oral intolerance. The semiological findings, laboratory tests (complete blood count, renal and hepatic function tests, acute phase reactants, serum electrolytes, serologies), radiological findings (chest X-ray and computed tomography of the abdomen and pelvis), biopsy, and therapeutic response were documented. The analysis was complemented by a literature review of current scientific literature on miliary tuberculosis. Conclusions: This case highlights the diagnostic difficulty of miliary tuberculosis, as the clinical presentation can mimic other systemic diseases. The integration of a multidisciplinary medical team and the biopsy results were key to establishing the diagnosis. Early treatment allowed for a favorable outcome, although prolonged follow-up is required to prevent relapses. In the context of our country, where tuberculosis remains a public health problem, the need to strengthen epidemiological surveillance and access to diagnostic tests is emphasized.