Cryptic miliary tuberculosis.
Fifteen patients with cryptic miliary tuberculosis seen over a six-year period in a large teaching hospital were reviewed. This form of tuberculosis tended to be difficult to diagnose and was most common in older people and those with underlying diseases such as malignancy or blood dyscrasias. Bacteriological investigation was of the little help in diagnosis while bone marrow and liver biopsies were more useful. The diagnosis was made during life in only seven (47 per cent) of the 15 cases, and the overall mortality was 80 per cent. Tuberculosis should be considered in all cases of pyrexia of unknown origin, and investigations performed to establish or exclude the diagnosis. A prompt and adequate therapeutic trial with antituberculous treatment even in the absence of definite evidence of tuberculosis can be life-saving.