A Case of Miliary Tuberculosis, Pneumothorax, and Pulmonary Thromboembolism: Original Image

A 30 years old woman complained of high fever and dyspnea. She delivered her 7(th) child 4 weeks ago. Symptoms had started after delivery and increased during the last 3 days. PA chest roentgenogram showed diffuse and bilateral miliary nodules. Physical examination revealed temperature 39.2 degrees C, pulse 130/min, arterial tension 90/60 mmHg, respiratory rate 35/min, and lung sounds normal. Deep venous thrombosis was detected in the right leg. SaO(2) was 69% and PaO2/FiO(2) was 86 while on 6 L/min O-2 inhalation. Computed tomography of thorax showed filling defects as well as miliary nodules. The tuberculin skin reaction was positive. Bilateral tuberculosis foci were seen in the choroid of retina. Treatment consisted of antituberculous drugs, anticoagulants, fluid and nutritional support. PaO2/FiO(2) rapidly improved. Recurrent pneumothorax developed. A tube thoracostomy was inserted. This case was interesting regarding the coexistence of miliary tuberculosis, recurrent pnomothorax, and venous thromboembolism.