Xin Yu, Yahui Huang, Yin Zhang, Xianglong Cai, Liangliang Liu, Na Zhang, Jingzhi Zhu, Xiaotong Xi, Ran Ding and Guoqiang Li*
Introduction: To investigate the clinical and chest imaging features of acute military tuberculosis with diffuse ground-glass opacities.
Methods: A case of acute military tuberculosis with diffuse ground-glass opacities was reported.
Results: The patient, a 52-year-old male, was hospitalized for 10 days with fever, and his body temperature fluctuated between 37.8° C and 40° C. The patient had a medical history of nephrotic syndrome for 20 years, lymph node tuberculosis for 10 years and viral hepatitis C for 3 years. There were no findings with Chest CT, and all 5 times of blood culture were negative during the first 12 days of the disease course. Metagenomic Next-Generation Sequencing (mNGS) was employed, revealing the detection of 13 specific reads belonging to M. tuberculosis complex, indicating the drug treatment on day 13. After receiving treatment with isoniazid, rifampicin, pyrazinamide and ethambutol, the highest body temperature of the patient decreased to 38.5° C on day 17. A follow-up chest CT scan showed diffuse ground-glass opacities, and mNGS data analysis revealed 27 specific reads of M. tuberculosis complex in Bronchoalveolar Lavage Fluid (BALF) on day 17. The highest body temperature of the patient decreased to 38° C on day 20. On day 33 of the disease course, a follow-up chest CT scan demonstrated typical imaging changes of miliary tuberculosis, and the body temperature of the patient returned to normal.
Conclusion: The imaging features of immunocompromised patients with acute miliary tuberculosis may manifest as diffuse ground glass opacities. mNGS with high sensitivity is valuable for early and accurate diagnosis, particularly in immunocompromised patients presenting with diffuse ground-glass opacities indicative of acute miliary tuberculosis.
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