Background Miliary tuberculosis (MT) refers to clinical disease resulting from lymphohematogenous dissemination of Mycobacterium tuberculosis. It affects primarily younger and immunocompromised children. Clinical presentation is highly variable and multiorgan involvement is common.

Clinical Case A nine-year Gypsy girl with a mild development delay and a history of epilepsy was presented to our hospital with a 19-day history of fever. She had completed two antibiotic treatments for suspected tonsillitis. Two years before she had had meningococcal meningitis. Family history was irrelevant. On admission, physical examination was normal and it was performed a chest radiography which revealed diffuse, bilateral, small lung nodules (Panel A). Ophthalmology diagnosed tubercular choroiditis in the right eye. An acute MT diagnosis was made. Lumbar puncture was normal and cranial magnetic resonance imaging showed several small nodular lesions - tuberculomas. Mantoux test: 14mm. In gastric aspirate cultures grew Mycobacterium tuberculosis without antibiotic resistance. Immune deficiency was excluded. She received antituberculosis therapy and fever resolved after 45 days. A nurse is going to her house daily to check the patient’s adherence during the one year treatment.

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Abstract 953 Figure 1

Chest radiography of miliary tuberculosis

Conclusion The diagnosis of MT can be clearly invoked with a simple and inexpensive investigation, even in an immunocompetent child. The typical image in the chest radiography is the most important reason to report this case.