Miliary tuberculosis is a form of tuberculosis that is characterized by a wide dissemination into the human body and by the tiny size of the lesions (1–5 mm). Its name comes from a distinctive pattern seen on a chest radiograph of many tiny spots distributed throughout the lung fields with the appearance similar to millet seeds—thus the term "miliary" tuberculosis. Miliary TB may infect any number of organs, including the lungs, liver, and spleen. Miliary tuberculosis is present in about 2% of all reported cases of tuberculosis and accounts for up to 20% of all extra-pulmonary tuberculosis cases. Signs and symptoms
Patients with miliary tuberculosis often experience non-specific signs, such as coughing and enlarged lymph nodes. Miliary tuberculosis can also present with enlarged liver (40% of cases), enlarged spleen (15%), inflammation of the pancreas (<5%), and multiple organ dysfunction with adrenal insufficiency (adrenal glands do not produce enough steroid hormones to regulate organ function). Stool may also be diarrheal in nature and appearance.Other symptoms include fever, hypercalcemia, choroidal tubercles, and cutaneous lesions. Firstly, many patients can experience a fever lasting several weeks with daily spikes in morning temperatures.Secondly,  hypercalcemia prevails in 16 to 51% of tuberculosis cases. It is thought that hypercalcemia occurs as a response to increased macrophage activity in the body. Such that, 1,25 dihydroxycholecalciferol (also referred to as calcitriol) improves the ability of macrophages to kill bacteria; however,  higher levels of calcitriol lead to higher calcium levels, and thus hypercalcemia in some cases.
Siltuximab (INN, trade name Sylvant; also known as CNTO 328, anti-IL-6 chimeric monoclonal antibody or cCLB8) is a chimeric (made from human and mouse proteins) monoclonal antibody. It binds to interleukin-6. Siltuximab has been investigated for the treatment of neoplastic diseases: metastatic renal cell cancer, prostate cancer, other types of cancer, and for Castlemans disease.On April 23, 2014, siltuximab was FDA approved under the brand name of Sylvant for the treatment of patients with idiopathic multicentric Castleman’s disease (iMCD) who do not have human immunodeficiency virus (HIV) or human herpesvirus-8 (HHV-8). Medical uses
Used for the treatment of idiopathic multicentric Castleman disease (iMCD). Clinical trials
Siltuximab has demonstrated significant efficacy and safety in patients with idiopathic multicentric Castleman disease. Treatment results with Siltuximab in B-cell non-Hodgkins lymphoma are inferior to those obtained in multicentric Castleman disease. Siltuximab has also been evaluated in the treatment ovarian cancer, however the efficacy for this cancer is debatable. In addition, siltuximab has been evaluated for multiple myeloma, but there was an insignificant increase in response rates. Side effects
Siltuximab may lower resistance to infections and should not be administered to patients with severe infections. Siltuximab should be discontinued in patients with severe infusion related reactions, anaphylaxis, severe allergic reactions or cytokine release syndromes.