Miliary Tuberculosis Diagnosed After Repeated Sputum Smear Examinations Despite Negative Results at a Referral Tuberculosis Center: The Importance of Maintaining Clinical Suspicion.

An 88-year-old woman with back pain was found to have destructive changes at T9/T10 and diffuse micronodular pulmonary opacities suggestive of miliary tuberculosis. At two referring hospitals, six sputum smears and two interferon-gamma release assays were negative. Because the clinical and radiological findings remained highly suggestive of tuberculosis, three additional sputum smears were obtained after admission, leading to rapid microbiological confirmation that avoided the need for invasive diagnostic procedures. This case highlights the importance of maintaining clinical suspicion and repeating sputum examination despite extensive negative evaluation elsewhere.