Miliary tuberculosis is usually seen in young children under 2 years of age or children with a weak immune system due to HIV infection or severe malnutrition. Miliary tuberculosis presents with the general signs and symptoms of tuberculosis (fever, lethargy, weakness and weight loss). In addition these children often have an enlarged liver and spleen. Miliary tuberculosis usually develops soon after the primary infection when TB bacilli ‘seed’ to many organs. The chest X-ray shows many small spots of pneumonia (‘a snow storm’ appearance).