This 70-year-old man was admitted to the hospital with a three week history of upper abdominal pain, anorexia, nausea, and general malaise, all of approximately three weeks' duration. His hospital stay was characterized by fever and severe respiratory distress. There were multiple densities in the patient's chest x-ray consistent with pneumonia and examination of a stained sputum specimen showed acid fast bacilli. Despite intensive appropriate therapy, the patient progressively deteriorated and died 14 days after admission. Autopsy findings demonstrated pulmonary tuberculosis with widespread dissemination throughout the body. Multiple gray-white nodules ranging from pinpoint size up to 1 cm were diffusely distributed throughout the lung parenchyma.