{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:13:37Z","timestamp":1790241217104,"version":"4.1.0"},"reference-count":15,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Miliary tuberculosis (TB) presents significant diagnostic challenges in resource\u2010limited, high\u2010burden regions when microbiological confirmation is unattainable. We describe a 65\u2010year\u2010old post\u2010menopausal Nepalese woman with prolonged fever, anemia, and constitutional symptoms. Initial chest radiography was inconclusive, but contrast\u2010enhanced computed tomography (CECT) revealed diffuse miliary nodules, calcified lymphadenopathy, and pleural effusion. Microbiological confirmation was precluded by the inability to expectorate and refusal of bronchoscopy. Empirical anti\u2010TB therapy (isoniazid, rifampicin, pyrazinamide, and ethambutol) was initiated based on radiological findings and epidemiological context (Nepal TB prevalence: 245\/100,000). The patient showed symptomatic and hematological improvement at follow\u2010up despite declining invasive diagnostics. This case underscores CT imaging's critical role in diagnosing miliary TB when microbiological evidence is unavailable and supports ethical empirical treatment in elderly patients from endemic regions where diagnostic limitations exist.<\/jats:p>","DOI":"10.1002\/ccr3.71196","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T05:46:57Z","timestamp":1759988817000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Miliary\n                    <scp>TB<\/scp>\n                    Without Microbiological Confirmation in a Post\u2010Menopausal Female: A Case From a High\u2010Burden Region"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9132-5296","authenticated-orcid":false,"given":"Jabir Ahamad","family":"Miya","sequence":"first","affiliation":[{"name":"Chitwan Medical College Teaching Hospital (CMCTH)  Bharatpur Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1990-902X","authenticated-orcid":false,"given":"Shishir","family":"Bhandari","sequence":"additional","affiliation":[{"name":"Chitwan Medical College Teaching Hospital (CMCTH)  Bharatpur Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7500-4751","authenticated-orcid":false,"given":"Pukar","family":"Adhikari","sequence":"additional","affiliation":[{"name":"Chitwan Medical College Teaching Hospital (CMCTH)  Bharatpur Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(05)70163-8"},{"issue":"4","key":"e_1_2_14_3_1","first-page":"493","article-title":"Clinical Characteristics of 110 Miliary Tuberculosis Patients From a Low HIV Prevalence Country","volume":"8","author":"Hussain S. F.","year":"2004","journal-title":"International Journal of Tuberculosis and Lung Disease"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199203053261011"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cger.2016.02.006"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.4046\/trd.2015.78.2.47"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-013-0478-z"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.5652.273"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.275065176"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2666-5247(22)00359-7"},{"key":"e_1_2_14_11_1","volume-title":"StatPearls","author":"Vohra S.","year":"2025"},{"key":"e_1_2_14_12_1","unstructured":"\u201cGlobal Tuberculosis Report 2024\u201d(2025) https:\/\/www.who.int\/teams\/global\u2010programme\u2010on\u2010tuberculosis\u2010and\u2010lung\u2010health\/tb\u2010reports\/global\u2010tuberculosis\u2010report\u20102024."},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2018-224166"},{"key":"e_1_2_14_14_1","unstructured":"\u201cNational Tuberculosis Management Guidelines 2019 Nepal|PDF|Tuberculosis|Infection \u201dScribd https:\/\/www.scribd.com\/document\/443681345\/National\u2010Tuberculosis\u2010Management\u2010Guidelines\u20102019\u2010Nepal."},{"key":"e_1_2_14_15_1","volume-title":"Treatment of Tuberculosis: Guidelines","author":"World Health Organization","year":"2010"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10245888"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.71196","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.71196","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.71196","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T08:51:45Z","timestamp":1790239905000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.71196"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":15,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1002\/ccr3.71196"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.71196","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"2025-08-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71196"}}