{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T08:35:32Z","timestamp":1783154132339,"version":"3.54.6"},"reference-count":23,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2018,9,5]],"date-time":"2018-09-05T00:00:00Z","timestamp":1536105600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>An immunocompetent 82-year-old female was admitted to our hospital due to fever without clear origin and hyponatremia. In the following days, an acute and bilateral pulmonary infiltrate appeared with a progressive worsening in respiratory function. Chest x-ray and CT (Computed tomography) showed bilateral reticulonodular infiltrates. Bronchoscopic aspiration and bronchoalveolar lavage (BAL), and transbronchial lung biopsy (TBBX) studies did not reveal microbiological and histopathological diagnosis. Broad-spectrum antibiotics were non-effective, and the patient died due to respiratory failure. Necropsy study revealed a miliary tuberculosis affecting lungs, liver, bone marrow, spleen, kidney, arteries, pancreas, and adrenal glands. Some weeks after the patient\u00b4s death, mycobacterial cultures from sputum, BAL and TBBX samples were positive for Mycobacterium tuberculosis.<\/jats:p>","DOI":"10.3390\/pathogens7030072","type":"journal-article","created":{"date-parts":[[2018,9,6]],"date-time":"2018-09-06T10:38:38Z","timestamp":1536230318000},"page":"72","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Miliary Tuberculosis Presenting with Hyponatremia and ARDS in an 82-Year-Old Immunocompetent Female"],"prefix":"10.3390","volume":"7","author":[{"given":"Benjam\u00edn","family":"Herreros","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Hospital Universitario Fundaci\u00f3n Alcorc\u00f3n, 28922 Madrid, Spain"},{"name":"School of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Plaza","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Hospital Puerta de Hierro, 28222 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebeca","family":"Garc\u00eda","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital Universitario Fundaci\u00f3n Alcorc\u00f3n, 28922 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Chich\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital Universitario Fundaci\u00f3n Alcorc\u00f3n, 28922 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Guerrero","sequence":"additional","affiliation":[{"name":"Department of Pathology, Hospital Universitario Fundaci\u00f3n Alcorc\u00f3n, 28922 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0846-4398","authenticated-orcid":false,"given":"Emilio","family":"Pintor","sequence":"additional","affiliation":[{"name":"School of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,9,5]]},"reference":[{"key":"ref_1","first-page":"703","article-title":"Challenges in the diagnosis & treatment of miliary tuberculosis","volume":"135","author":"Sharma","year":"2012","journal-title":"Indian J. Med. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.5588\/ijtld.10.0557","article-title":"Acute respiratory distress syndrome caused by miliary tuberculosis: A multicentre survey in South Korea","volume":"15","author":"Lee","year":"2011","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_3","first-page":"157","article-title":"Acute respiratory distress syndrome (ARDS) in miliary tuberculosis: A twelve year experience","volume":"38","author":"Mohan","year":"1996","journal-title":"Indian J. Chest Dis. Allied Sci."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Reichmann, M.T., Marshall, B.G., Cummings, F., and Elkington, P.T. (2014). Tuberculosis and TNF-inhibitors: History of exposure should outweigh investigations. BMJ Case Rep.","DOI":"10.1136\/bcr-2013-202127"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jctube.2016.03.003","article-title":"Miliary tuberculosis: A new look at an old foe","volume":"3","author":"Sharma","year":"2016","journal-title":"J. Clin. Tuberc. Other Mycobact. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e5875","DOI":"10.1097\/MD.0000000000005875","article-title":"Miliary tuberculosis","volume":"96","author":"Mert","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Singh, K., Hyatali, S., Giddings, S., Singh, K., and Bhagwandass, N. (2017). Case Report Miliary Tuberculosis Presenting with ARDS and Shock: A Case Report and Challenges in Current Management and Diagnosis. Case Rep. Crit. Care.","DOI":"10.1155\/2017\/9287021"},{"key":"ref_8","first-page":"429","article-title":"Predictors of development and outcome in patients with acute respiratory distress syndrome due to tuberculosis","volume":"10","author":"Sharma","year":"2006","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_9","first-page":"160","article-title":"The adult respiratory stress syndrome and septic shock associated with tuberculosis","volume":"195","author":"Boronat","year":"1995","journal-title":"Rev. Clin. Esp."},{"key":"ref_10","first-page":"E1","article-title":"Acute respiratory distress syndrome with miliary tuberculosis: A fatal combination","volume":"5","author":"Gupta","year":"2013","journal-title":"J. Thorac. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"687","DOI":"10.5812\/numonthly.7091","article-title":"Hyponatremia Due to Pulmonary Tuberculosis: Review of 200 Cases","volume":"5","author":"Jafari","year":"2012","journal-title":"Nephrourol. Mon."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Underwood, J., Cresswell, F., Salam, A.P., Keeley, A.J., Cleland, C., John, L., and Davidson, R.N. (2017). Complications of miliary tuberculosis: Low mortality and predictive biomarkers from a UK cohort. BMC Infect. Dis., 17.","DOI":"10.1186\/s12879-017-2397-6"},{"key":"ref_13","first-page":"493","article-title":"Clinical characteristics of 110 miliary tuberculosis patients from a low HIV prevalence country","volume":"8","author":"Hussain","year":"2004","journal-title":"Int. J. Tuberc. Lung. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1590\/s1806-37562017000000459","article-title":"Chest X-ray and chest ct findings in patients diagnosed with pulmonary tuberculosis following solid organ transplantation: A systematic review","volume":"44","author":"Giacomelli","year":"2018","journal-title":"J. Bras. Pneumol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1259\/bjr\/95169618","article-title":"Miliary tuberculosis: A comparison of CT findings in HIV-seropositive and HIV-seronegative patients","volume":"83","author":"Kim","year":"2010","journal-title":"Br. J. Radiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s15010-015-0865-8","article-title":"Miliary tuberculosis: Sonographic pattern in chest ultrasound","volume":"44","author":"Hunter","year":"2016","journal-title":"Infection"},{"key":"ref_17","first-page":"641","article-title":"Indications, diagnostic yields and complications of transbronchial biopsy over 5 years in the State of Qatar","volume":"26","author":"Ibrahim","year":"2005","journal-title":"Saudi Med. J."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Gupta, M., Lobo, F.D., Adiga, D.S.A., and Gupta, A. (2016). A histomorphological pattern analysis of pulmonary tuberculosis in lung autopsy and surgically resected specimens. Pathol. Res. Int.","DOI":"10.1155\/2016\/8132741"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"42","DOI":"10.5144\/0256-4947.2016.42","article-title":"Clinically unrecognized miliary tuberculosis: An autopsy study","volume":"36","author":"Savic","year":"2016","journal-title":"Ann. Saudi Med."},{"key":"ref_20","first-page":"162","article-title":"Miliary tuberculosis: The role of necropsy studies","volume":"25","year":"2017","journal-title":"Infez. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1272\/jnms.78.305","article-title":"Autopsy cases of miliary tuberculosis: Clinicopathologic features including background factors","volume":"78","author":"Tajiri","year":"2011","journal-title":"J. Nippon Med. Sch."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1007\/s001340000849","article-title":"Delayed treatment contributes to mortality in ICU patients with severe active pulmonary tuberculosis and acute respiratory failure","volume":"27","author":"Zahar","year":"2001","journal-title":"Intensive Care Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1111\/crj.12437","article-title":"The successful treatment of refractory respiratory failure due to miliary tuberculosis: Survival after prolonged extracorporeal membrane oxygenation support","volume":"10","author":"Nam","year":"2016","journal-title":"Clin. Respir. 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