Objective: To analyze the clinical characteristics and treatment of hematogenous disseminated tuberculosis.
Methods: Twenty-seven cases of hematogenous disseminated tuberculosis diagnosed by autopsy from 1961 to 2000 were retrospectively analyzed.
Results: Among these patients the disease was acute in 22 cases (including 3 non-reactive) and chronic in 5. Twenty cases (74%) were misdiagnosed before death, most of which were due to concomitant with or misdiagnosed as connective tissue disease, hematological disease or tumor. 63% of the cases had long-term use of corticosteroids or repeated chemotherapy. Most cases showed atypical clinical manifestations and chest X-ray lesions. The positive rate of tuberculin skin test and sputum for smear were low. Autopsy showed that all cases had active lung tuberculosis and the major extra-pulmonary organs involved were liver, spleen and lymph nodes.
Conclusion: Unaware of the risk for tuberculosis among immune compromised patients was the main reason for misdiagnosis and corticosteroid abuse was common. Physician should be alert to the occurrence of hematogenous disseminated tuberculosis, especially in immune compromised patients with long-term fever and systemic injury. Direct smear and cultural examination as well as newer diagnostic approaches with sputum and tissue may be useful for a rapid and correct diagnosis.