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The patient had seen multiple providers who had diagnosed her with community-acquired pneumonia, but she was unimproved after oral antibiotic therapy. On presentation, she was noted to be febrile, tachycardic and chronically ill-appearing. Her chest X-ray showed diffuse opacities and a right upper lobe cavitary lesion concerning for tuberculosis. A subsequent chest CT revealed miliary pulmonary nodules in addition to the cavitary lesion. The patient underwent subsequent brain MRI, which revealed multifocal ring-enhancing nodules consistent with parenchymal involvement. The patient was diagnosed with miliary tuberculosis and improved on quadruple therapy. Though rates of tuberculosis are increasing, rates remain low in children, though special consideration should be given to children who are immunosuppressed.<\/jats:p>","DOI":"10.1136\/bcr-2020-237580","type":"journal-article","created":{"date-parts":[[2021,3,9]],"date-time":"2021-03-09T10:50:53Z","timestamp":1615287053000},"page":"e237580","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Miliary tuberculosis in a paediatric patient with psoriasis"],"prefix":"10.1136","volume":"14","author":[{"given":"Jacob","family":"Kilgore","sequence":"first","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Duke University Hospital, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathon","family":"Pelletier","sequence":"additional","affiliation":[{"name":"Division of Pediatric of Critical Care Medicine, UPMC, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradford","family":"Becken","sequence":"additional","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Duke University Hospital, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Kenny","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, King Edward VII Memorial Hospital, Paget, Bermuda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samrat","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Duke University Hopistal, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Parnell","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Duke University Hopistal, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,3,9]]},"reference":[{"key":"2025082712443643000_14.3.e237580.1","doi-asserted-by":"crossref","DOI":"10.4103\/2156-7514.124087","article-title":"Cystic and cavitary lung lesions in children: radiologic findings with pathologic correlation","volume":"3","author":"Odev","year":"2013","journal-title":"J Clin Imaging Sci"},{"key":"2025082712443643000_14.3.e237580.2","doi-asserted-by":"crossref","first-page":"407","DOI":"10.4132\/KoreanJPathol.2012.46.5.407","article-title":"Pathologic review of cystic and cavitary lung diseases","volume":"46","author":"Kim","year":"2012","journal-title":"Korean J Pathol"},{"key":"2025082712443643000_14.3.e237580.3","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1007\/s00247-017-3866-1","article-title":"Imaging of thoracic tuberculosis in children: current and future directions","volume":"47","author":"Sodhi","year":"2017","journal-title":"Pediatr Radiol"},{"key":"2025082712443643000_14.3.e237580.4","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s40121-013-0003-9","article-title":"Psoriasis, anti-tumor necrosis factor therapy, and tuberculosis: report of three challenging cases and literature review","volume":"2","author":"Solovan","year":"2013","journal-title":"Infect Dis Ther"},{"key":"2025082712443643000_14.3.e237580.5","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00040-08"},{"key":"2025082712443643000_14.3.e237580.6","doi-asserted-by":"crossref","first-page":"e139","DOI":"10.1097\/MJT.0b013e3181ee7391","article-title":"Disseminated tuberculosis secondary to adalimumab","volume":"19","author":"Pednekar","year":"2012","journal-title":"Am J Ther"},{"key":"2025082712443643000_14.3.e237580.7","doi-asserted-by":"crossref","DOI":"10.1016\/j.jctube.2019.100113","article-title":"Miliary tuberculosis and acute respiratory distress syndrome","volume":"16","author":"Boushab","year":"2019","journal-title":"J Clin Tuberc Other Mycobact Dis"},{"key":"2025082712443643000_14.3.e237580.8","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1007\/s00381-019-04270-5","article-title":"Pediatric miliary tuberculosis presenting with stroke: contribution to the paper \"Tuberculosis of the central nervous system in children\"","volume":"35","author":"S\u00e1nchez-C\u00f3dez","year":"2019","journal-title":"Childs Nerv Syst"},{"key":"2025082712443643000_14.3.e237580.9","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw376"},{"key":"2025082712443643000_14.3.e237580.10","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00042-07"},{"key":"2025082712443643000_14.3.e237580.11","unstructured":"CDC . 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