This case study of generalized miliary tuberculosis in a Brazilian man without AIDS is reported in order to emphasize the role of histopathological study for diagnosis. We comment on a recent Indian study involving 40 cases of surgical and necropsy specimens in which the diagnosis of tuberculosis was made, as well as a previous Brazilian case report. The authors believe that non-specialists should be better informed about the possibility of miliary tuberculosis, which involves clinical diagnostic challenges. Despite limitations, minimally invasive necropsy may be an alternative to elucidate causes of death in low-income countries.