PMC3420530_01
CT findings. (a) On admission, nodular and macular shadows in the right upper and intermediate lobes and left inferior lobe and ground-glass opacities in both inferior lobes were seen. (b) On day 4, interstitial opacity improved. (c) On day 15, interstitial opacity was worsened. (d) On day 34, miliary nodules were seen in both lung fields, but interstitial shadows were ameliorated.
CRIM.PULMONOLOGY2011-268620.001.jpg
PMC3420530_01_CRIM.PULMONOLOGY2011-268620.001.jpg
fig1
Computed tomography (CT) of the chest revealed nodular and macular shadowing in the right upper and middle lobes and left inferior lobe and ground-glass opacities in both inferior lobes (Figure 1(a)). On day 4, respiratory status and interstitial opacity on CT were improved (Figure 1(b)). However, fever recurred on day 10 and respiratory status and CT findings were deteriorated on day 15 (Figure 1(c)). On day 34, CT was performed to followup the interstitial pneumonia and fever, revealing miliary nodules in both lung fields, typical of miliary tuberculosis, although interstitial shadows had disappeared (Figure 1(d)).
Pathological findings for the liver. (a) Hematoxylin and eosin (HE) staining showing Langhans' giant cell and noncaseating granuloma (x400). (b) Positive results for Ziehl-Neelsen staining (x400).
CRIM.PULMONOLOGY2011-268620.002.jpg
PMC3420530_01_CRIM.PULMONOLOGY2011-268620.002.jpg
fig2
On day 23, Liver biopsy confirmed Langhans' giant cell and noncaseating granuloma (Figure 2(a)). Ziehl-Neelsen staining obtained positive results in a liver specimen (Figure 2(b)), but negative results in a lung specimen.
Clinical course after admission.
CRIM.PULMONOLOGY2011-268620.003.jpg
PMC3420530_01_CRIM.PULMONOLOGY2011-268620.003.jpg
fig3
Prednisolone was gradually tapered to 30 mg/day, and the patient was discharged without recurrence of the disease on day 100 (Figure 3).
CT findings. (a) On day 34, miliary nodules were seen in both lung fields, but interstitial shadows were ameliorated. (b) On day 58, miliary nodules had almost disappeared from both lung fields. (c) On day 68, new shadowing appeared in both upper lobes. (d) Sickly shadowing had disappeared by day 72.
CRIM.PULMONOLOGY2011-268620.004.jpg
PMC3420530_01_CRIM.PULMONOLOGY2011-268620.004.jpg
fig4
Although miliary nodules in both lung fields had almost disappeared (Figure 4(b)), sickly shadowing was newly apparent in both upper lobes (Figure 4(c)). Thereafter, fever subsided and the sickly shadowing had disappeared by day 72 (Figure 4(d)).