Miliary tuberculosis presenting with rigors and developing unusual cutaneous manifestations.

We report a case of miliary tuberculosis presenting with high fevers and rigors. While undergoing evaluation, the patient developed a diffuse, erythematous, maculopapular eruption coalescing to form erythematous plaques involving the abdomen, trunk, and proximal extremities. Biopsies of the lesions were smear- and culture-negative for Mycobacterium tuberculosis. Rigors are an unusual presenting symptom of miliary tuberculosis and have only been reported three times in the (post-antibiotic era) literature. Chills have been reported to occur 28% of the time. This symptom can be confusing to the practitioner, leading to delay in diagnosis. The skin lesions were most consistent with a lichenoid tuberculid eruption. The patient had a negative purified protein derivative and non-reactive anergy panel, and the lesions involved only the cutis and healed without scarring. The patient had a dramatic response to antituberculous therapy, with resolution of the fever within 2 days and resolution of the rash within 2 weeks.