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A case of anxiety associated with miliary tuberculosis

Authors Alosaimi F, Alkharboush F, Altuwariqi M

Received 26 March 2014

Accepted for publication 22 April 2014

Published 20 June 2014 Volume 2014:7 Pages 111—115


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Fahad D Alosaimi,1 Feras A Alkharboush,2 Maram H Altuwariqi1

1Department of Psychiatry, King Saud University, Riyadh, Kingdom of Saudi Arabia; 2College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia

Abstract: Miliary tuberculosis (TB) is a serious infection with various presentations that can perplex even the most experienced clinicians. To our knowledge, there is a lack of published reports that link psychiatric symptoms directly with miliary TB (either alone or co-occurring with other medical symptoms). Mental health workers may, therefore, not consider, and consequently miss, this important diagnosis. Here we are reporting a case of cyclical anxiety occurring in a 67-year-old patient. For 3 years prior to admission, the patient failed to respond to multiple courses of different antianxiety medications. The patient required hospital admission as he deteriorated and had a reduced level of consciousness. A chest X-ray revealed bilateral nodules and a magnetic resonance imaging scan showed multiple enhancing tuberculous lesions in the cerebral white matter, brain stem, and cerebellum. A diagnosis of miliary TB was finally made. Several characteristics of this case suggest that the diagnosed anxiety disorder was due to miliary TB. However, we cannot exclude the possibility that generalized anxiety disorder preceded the onset of miliary TB or that both diseases were coincidental. The report serves as a reminder that organic causes for psychiatric symptoms always need to be considered, particularly if they follow an atypical pattern or fail to improve with usual psychiatric medications.

Keywords: anxiety disorder, elderly, psychosomatic, case report, Saudi Arabia

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