Miliary Tuberculosis with Bone Marrow Aspirate Granulomas Presenting as Obstructive Jaundice- Rare Presentation & Rare Finding In Common Disease- A Case Report

Abstract

Miliary tuberculosis (MTB) is a disseminated form of tuberculosis which may involve the lungs and other organs. Granulomas in bone marrow aspirate are an infrequent finding. Obstructive jaundice as the sole presentation of miliary tuberculosis is a rare entity. We reported a case of 64-year old male presented with complaints of jjaundice, pedal edema, anorexia and nausea for 5 days. A provisional diagnosis of obstructive jaundice with anemia was made. Lab investigations reveal increased bilirubin and alkaline phosphatase levels, anemia and high ESR. Bone marrow aspiration cytology show many granulomas. Chest X ray show ddiffuse miliary mottling in both lungs and HRCT show features suggestive of MTB. Based on bone marrow aspirate granulomas and radiological findings, a possibility of the tuberculous etiology suggested and empirical treatment with a four-drug anti-tuberculous regimen initiated and treated successfully with complete resolution of symptoms before confirmation of aspirate sample by radiometric culture.