[A young girl with abdominal pain]

Abdominal pain combined with fever is common during childhood. We present a 12-year-old girl who was admitted to hospital with abdominal pain, fever and nausea, but she also complained of cough, weight loss and night sweat. Investigations revealed multiple and randomly distributed lung nodules, impaired lung function, meningitis and multiple small brain lesions, consistent with tuberculomas. The polymerase chain reaction was positive for Mycobacterium tuberculosis in sputum. Cultures of sputum and cerebrospinal fluid were also positive and confirmed miliary tuberculosis with concomitant meningitis. The result of the Mantoux test was 13 mm and that of the Quantiferon-TB Gold was 5.17 IU/ml. She was given four antituberculous drugs (isoniazide, rifampicin, pyrazinamide and ethambutol) for two months and two drugs (isoniazide and rifampicin) for an additional ten months. The intracranial tuberculomas increased in size during the first two months of treatment, but demonstrated regression after seven months. The girl was HIV-negative and had no sign of immunodeficiency, but had recently been ill with mononucleosis and varicella infections. She recovered completely. The combination of miliary tuberculosis and meningitis is uncommon, particularly among previously healthy children of this age. Temporary immune suppression, caused by viral infections, could possibly explain the unusual clinical course. Pediatricians should be aware of miliary tuberculosis as a possible diagnosis in children presenting with common symptoms.