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Pulmonary langerhans cell histiocytosis masquerading as tuberculosis in an infant

M P Senanayake1, S Mettananda, M V C De Silva

  • 1Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.

Annals of Tropical Paediatrics
|November 2, 2011
PubMed

Insights

A 4-month-old infant with suspected tuberculosis (TB) was diagnosed with pulmonary Langerhans cell histiocytosis after recurrent pneumothorax. Prompt diagnosis and treatment with chemotherapy led to symptom resolution, highlighting the need for alternative diagnoses in high-prevalence areas.

Area of Science:

  • Pediatric Pulmonology
  • Rare Diseases
  • Medical Diagnostics

Background:

  • Tuberculosis (TB) is a significant concern in high-prevalence communities, often presenting with respiratory symptoms.
  • Infants with persistent fever and bronchopneumonia may initially be suspected of having TB.

Observation:

  • A 4-month-old infant presented with persistent fever and unresolving bronchopneumonia, with a history of household TB contact.
  • The infant showed only marginal improvement on anti-TB chemotherapy, and recurrent pneumothorax raised diagnostic questions.

Findings:

  • High-resolution CT scan and open lung biopsy confirmed pulmonary Langerhans cell histiocytosis (PLCH).
  • Treatment with prednisolone and vinblastine resulted in fever resolution and improvement of respiratory signs and symptoms.

Implications:

  • Unusual presentations of respiratory illness in high TB prevalence areas necessitate considering alternative diagnoses beyond TB.
  • Pulmonary Langerhans cell histiocytosis should be considered in infants with persistent respiratory symptoms and pneumothorax, even with TB exposure.
  • Accurate diagnosis through advanced imaging and biopsy is crucial for effective treatment of rare pediatric lung diseases.

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