Leukopenia and consumption coagulopathy in miliary tuberculosis

Unusual clinical courses and symptoms in miliary tuberculosis cause difficulties in early diagnosis. In a patient with fever of unknown origin, leuko- and thrombocytopenia and hypoplastic bone marrow, tuberculous infection was not diagnosed because drug-induced damage to bone marrow was assumed. A second patient with squamous cell carcinoma of the tongue, miliary tuberculosis and leuko- and thrombocytopenia died in spite of intensive antituberculous therapy. A further patient with miliary tuberculosis developed respiratory distress syndrome and disseminated intravascular coagulation. In fever of unknown origin, unexplained blood disorders, hyponatremia and respiratory distress syndrome without evident cause, "cryptic" miliary tuberculosis should be considered in established the differential diagnosis.