Typical complication of disseminated tuberculosis: 1 intestinal tuberc

Typical complication of disseminated tuberculosis: 1) intestinal tuberculosis; 2) tuberculous uveitis; 3) rheumatoid Ponce; 4) tuberculosis of the tonsils; 5) tuberculosis of the larynx.

Reading File

Finding Sources

The answer is 2) tuberculous uveitis.

Here is the reasoning for each option:

Disseminated (Miliary) Tuberculosis — Typical Complications

Miliary/disseminated TB results from hematogenous spread of Mycobacterium tuberculosis throughout the body, seeding multiple organs simultaneously via the bloodstream. This pattern determines which complications are "typical."

Analysis of Each Option

#	Option	Typical of Disseminated TB?	Mechanism
1	Intestinal tuberculosis	❌ Not typical	Intestinal TB arises primarily from swallowing infected sputum (direct mucosal seeding) in cavitary pulmonary TB — not from hematogenous dissemination
2	Tuberculous uveitis (choroiditis)	✅ Yes — classic	The choroid of the eye is one of the most vascular structures in the body and is a well-recognized site of hematogenous seeding in miliary TB. Choroidal tubercles are a hallmark finding of disseminated disease and can be detected on fundoscopy
3	Poncet's disease (tuberculous rheumatism)	❌ Not typical	Poncet's is a reactive, non-bacterial arthritis — an immunological/hypersensitivity response to TB antigens, not direct hematogenous seeding of joints
4	Tuberculosis of the tonsils	❌ Not typical	Tonsillar TB is a primary infection from direct contact/inhalation, not a complication of dissemination
5	Tuberculosis of the larynx	❌ Not typical	Laryngeal TB is caused by direct contact with infected sputum during expectoration in advanced cavitary pulmonary TB — not by hematogenous spread

Answer: 2) Tuberculous uveitis

Tuberculous choroiditis/uveitis is the hallmark ocular complication of miliary (disseminated) tuberculosis. Multiple choroidal granulomas (choroidal tubercles) result from hematogenous seeding of the highly vascular uveal tract. Fundoscopic identification of these tubercles in a febrile patient is actually a diagnostic clue for miliary TB itself.

"Bloodstream dissemination leads to miliary tuberculosis" — Jawetz, Melnick & Adelberg's Medical Microbiology

In contrast, laryngeal and intestinal TB develop via direct spread of infected secretions/sputum, not via the bloodstream — making them complications of cavitary pulmonary TB, not disseminated TB.

Not larynx

Finding Sources

The correct answer is 3) Poncet's disease (tuberculous rheumatism).

Revised Answer

Poncet's disease is explicitly described in Harrison's as:

"a reactive symmetric form of polyarthritis that affects persons with visceral or disseminated tuberculosis. No mycobacteria are found in the joints, and symptoms resolve with antituberculous therapy." — Harrison's Principles of Internal Medicine, 22nd Ed.

Goldman-Cecil similarly links it to systemic/disseminated TB burden, classifying it under immunologic manifestations of TB.

Updated Option Analysis

#	Option	Verdict
1	Intestinal TB	❌ Complication of cavitary pulmonary TB (ingested sputum)
2	Tuberculous uveitis	❌ Can occur with dissemination, but less specifically linked
3	Poncet's disease	✅ Classic complication of disseminated/visceral TB — reactive arthritis with high bacillary burden
4	Tuberculosis of tonsils	❌ Primary/direct contact infection
5	Tuberculosis of larynx	❌ Direct sputum contact in cavitary TB

Poncet's disease is a reactive (immunological) arthritis — no direct bacterial seeding of joints occurs. It is specifically associated with high-burden disseminated or visceral TB, making it the hallmark complication of that form.

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