The diagnosis of tuberculous bacillemia is extremely difficult and therefore is not made frequently during the patient's lifetime. Only later on, when one organ, such as a joint, the kidney or the meninges, becomes involved, or when generalized miliary tuberculosis results, can the initial tentative diagnosis be proved.
Three clinical pictures of miliary tuberculosis are most frequently seen, the typhoidal, the meningeal and the pulmonary types, the last being relatively rare in children. Even at the onset of miliary tuberculosis there are few signs to support the diagnosis, since tuberculides, miliary tubercles on the fundi of the eyes and positive roentgenologic findings appear relatively late and the tuberculin reaction is negative in many patients.
In rare instances, miliary tuberculosis may resemble the clinical picture of rheumatic fever, with polyarthritis and carditis as the predominant criteria for the diagnosis. In 1864, Charcot1 described a large number of patients with polyarthritis