28 yrs old soldier, presented with history of cough wid expectoration, night sweats of 3 mnths duration. History of wt loss of around 10 kgs present..on examn no lnpathy, no hepatosplenomegaly, no peripheral stgmatas of TB. Auscultation revealed b/l crepts..Mantoux, AFB×3 negative..HIV negative..PFT reveals severe restriction..Xray n CT images attached..Differential diagnosis..



1Its miliary bottling over both lung fields...differentials include.. Miliary tb Lymphangitis carcinomatis sarcoidosis Hypereosinophilic syndrome Primary alveolar proteinosis In this context better to rule out hypeeosinophilic syndrome since he is soldier..can work up for other causes also..

In absence of ny lymphadenopathy..neither peripheral nor retroperitoneal..lymphangitis carcinomatosis frm primary else whr z unlikely..BAL cytology shows atypical cells..random TBLB done..report awaited..initialy patient ws managed on d lines of miliary Kochs for 1 month..bt showing no improvement..i ll update on d biopsy reports soon..may b in a day or two as soon as avlbl..for info pt is a non smoker..

Ya Biopsy report n BAL will give exact diagnosis. . Pls update that when you get the report.

Frst look at d x-ray or CT makes every 1 of us of milliary TB in ds case..But in d absence of ny lnpathy, organomegaly, peripheral stigmatas, no response to ATT as wel as no h/o immunosupression..has alerted us to go for TBLB.. TBLB..cnfrmed adenocarcinoma, lepidic variant..Ds variant z known to spread along airways..d name like leopard..so lepidic. Nxt step z to get mutational status of EGFR/ALK..whch z present in around 50% of asians having adeno ca who r non smokers ( particularly females ). Ds case z jst to sensitize evry1 about d unusual presentation of malignancy. Thnx all for der valuable inputs. Regards

i think this is the case of disseminated miliary tb , we should give AKT WITH STEROID a/c to wt . and with bronchodilator and symptomatics . and BAL fluid lavage to guide further D/D.

It appears like lymphangitis carcinomatosis. Primary needs to be searched for. USG of testes, sputum cytology for malignant cells, bronchoscopy followed by BAL fluid cytology for malignant cells.

it could be 1.hypereosinophilic syndrome2.sarcoidosis 3.lymphangitic carcinamaosis 4.miliary tb

Pls do and usg for liver and splenic granulomatosis and for other lymph nodes GI scope can show lesions unexpectedly Do bone marrow aspiration and a good bone biopsy as they can reveal granulomatosis Is there history of any drug use like NSAID or other history of work related exposure to allergens

CT chest s/o ild.start injectable steroid and do a gene xpert for M.tuberculosis in sputum sample.

Gene xpert negative Ig E levels normal Pt on ATT since 1 mntn..no relief of symptoms

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Eosinophilic pnemonitis Miliary tb

dr.dubey do genexpert sputum test for molecular tb and drug resistance in tb need to stain sputum for fungal stain and c/s and start antifungal adulf 200mg iv start then 100mg od after sputum report tb with fungemia will be there thanks

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