Four cases of acute miliary tuberculosis, including one case of nonreactive tuberculosis, are reported in this article. Final diagnoses were proved by autopsy. Literature review shows that symptoms of the disease vary greatly in different cases, but fever with unknown causes and overwhelming infection is the constant features. Nonreactive tuberculosis is common in the patients with low immunity and correct diagnosis depends on autopsy in most cases. Anti-tuberculosis drugs for nonreactive tuberculosis is not very effective and the prognosis is unfavourable. This article provides for the doctors with the experience of mis-diagnosis of acute miliary tuberculosis, especially nonreactive tuberculosis.