the most important factor responsible for mortality in miliary TB. The varied clinical manifestations, atypical radiographic indings and dif iculties in establishing TB as the aetiological diagnosis, among others, are challenges in diagnosis and treatment of miliary TB. The typical chest radiograph indings may not be evident till late in the disease. Patients with miliary TB classically present with fever with evening rise of temperature for several weeks duration, anorexia, weight loss, weakness and cough. However, fever may be absent and the patients may present with progressive wasting strongly mimicking a metastatic carcinoma. Dry cough and dyspnoea are often present. 41. Can pulmonary tuberculosis be misinterpreted as lung cancer at autopsy? Yes, I have encountered a case in which the convict presented with respiratory complaints within 1 week of his entry in the prison and then after about 5 weeks, he presented with haemoptysis, cough with expectoration and chest pain. For which he was referred to medical college and subsequently to RNTCP (Revised national tuberculosis control program) centre where x-ray and CT scan were also done. He was diagnosed as having pulmonary tuberculosis and was put on Category -1 ATT (anti-tubercular treatment). But subsequently he developed chest complication (pleural effusion) and lung collapse and expired during treatment. The post-mortem report mentioned lung indings as “well de ined tumour mass on apical region placed at central region on right main bronchus”. Tuberculosis is well known as a diagnostic chameleon and can resemble carcinoma of lung. The well de ined tumour mass on apical region of lung without any in iltrative appearance and absence of metastatic indings in the surrounding, other lung or abdominal viscera is not consistent with the indings as seen in a patient dying due to carcinoma lungs. Especially in absence of histo-pathological diagnosis of the diseased condition of lungs, the post-mortem diagnosis based upon gross post-mortem indings may be more so a misinterpretation. The indings in this case were more corroborating with the clinical/ante-mortem diagnosis of pulmonary tuberculosis. 42. How tuberculosis progresses in a patient suffering from it? MEDICAL DIMENSION OF FREQUENTLY ENCOUNTERED CASES | 42