Cryptic tuberculosis: a missed diagnosis and an unusual presentation
Keywords:Bacterial infection, Diagnosis, Respiratory tract, Treatment, Tuberculosis
AbstractCryptic tuberculosis is a rare and atypical clinical presentation of disseminated hematogenously spread tuberculosis, in which the usual diagnostic criteria for tuberculosis, especially the roentgenographic evidence, are lacking. Here we report a case of an elderly female with prolonged respiratory distress, persistent anaemia, with thrombocytopenia and hypoproteinaemia; inspite of long term treatment and normal X-ray chest. Diagnosis of cryptic tuberculosis was established only after histopathology report of a late appearing axillary lymph node during the course of treatment. The incidence of these occult forms of tuberculosis, where diagnosis is often established too late or entirely missed, is significant. This possibility must be kept in mind in severe infectious conditions and pyrexia of unknown origin without obvious aetiology.
Jacques J, Sloan J. The changing pattern of miliary tuberculosis. Thorax. 1970;25(2):237-40.
Vasankari T, Liippo K, Tala E. Overt and cryptic miliary tuberculosis misdiagnosed until autopsy. Scand J Infect Dis. 2003;35:794-6.
Proudfoot AT, Akhtar AJ, Douglas AC, Horne NW. Miliary tuberculosis in adults. BMJ. 1969;2:273-6.
Sharma SK, Mohan A. Extra-pulmonary tuberculosis. Indian J Med Res. 2004;120:316-53.
Sharma SK, Mohan A. Miliary tuberculosis. In Agarwal AK. editor. Clinical medicine update – 2006.New Delhi: Indian Academy of Clinical Medicine. 2006:353-60.
Sharma SK, Mohan A, Sharma A, Mitra DK. Miliary tuberculosis: new insights into an old disease. Lancet Infect Dis. 2005;5:415-30.
Sharma SK, Mohan A, Pande JN, Prasad KL, Gupta AK, Khilnani GC. Clinical profile, laboratory characteristics and outcome in miliary tuberculosis. QJ Med. 1995;88:29-87.