Prolonged high-frequency oscillatory ventilation in tubercular multifocal cystic lung disease

Multifocal cystic lung disease in infants is most commonly congenital, and is managed surgically with perioperative mechanical ventilation. Multifocal cystic lung disease in infants may be due to tuberculosis. We report a young infant with tubercular multifocal cystic lung disease and respiratory failure. The initial chest imaging revealed diffuse nodular infiltrates. Soon after admission he required conventional mechanical ventilation for respiratory failure. The bronchoalveolar lavage fluid grew Mycobacterium tuberculosis in culture. Subsequent chest imaging showed progression to multifocal cystic lung disease. The ventilation mode was changed to high-frequency oscillatory ventilation (HFOV) due to persistent CO(2) retention in the presence of cystic lung disease. The cystic lung disease reversed with antitubercular treatment and prolonged HFOV with slow wean.