Case 394

Medical history

A 66-year-old female, reporting diffuse abdominal pain, asthenia, recurrent fever, dyspnea and dry cough for the past 3 weeks. She was treated with amoxicillin for 7 days, with no improvement. Under treatment with adalimumab for Crohn’s disease. Contact with a co-worker with tuberculosis, but the tuberculin skin test from the previous year was negative. On examination: 38.2°C, SpO2 85%, RR 24 bpm, jaundice, normal pulmonary auscultation, palpable liver at 7 cm from the RHC. Chest radiographs were requested (images 1 and 2). Sputum smear microscopy was negative for BAAR and the rapid molecular test was positive for M. tuberculosis.

Based on the clinical history and the examination, the most likely diagnosis is:

Test question

[Municipal Health Department of São José dos Pinhais - PR (Direct Access 1)] The diagnosis of Miliary Tuberculosis (TBM) can be suggested by chest CT and confirmed by biopsies.

Of the options mentioned below, which one has the highest yield for diagnosing TBM?

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