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Miliary tuberculosis disease complicated by Pott's abscess in an infant: Seven year follow-up
Gulsum Iclal Bayhan1, Gonul Tanir1, Zeynep Gokce Gayretli Aydın1
1Department of Pediatric Infectious Disease, Dr. Sami Ulus Maternity and Children's Health Education and Research Hospital, Ankara, Turkey.
Insights
Miliary tuberculosis (TB) complicated by Pott's disease is rare in children. Early diagnosis and treatment of this severe TB form led to a full recovery, with only minor residual kyphosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Radiology
Background:
- Miliary tuberculosis (TB) is a disseminated form of TB.
- Pott's disease, or tuberculous spondylitis, affects the spine.
- Concurrent miliary TB and Pott's disease in children is exceptionally rare.
Purpose of the Study:
- To report a rare case of miliary tuberculosis complicated by Pott's disease in a pediatric patient.
- To highlight the diagnostic challenges and treatment outcomes for this severe presentation of childhood TB.
Main Methods:
- Case presentation of a 20-month-old boy with persistent symptoms.
- Diagnostic imaging included abdominal ultrasonography and thoracic computed tomography.
- Laboratory tests involved acid-resistant bacilli analysis, mycobacterial cultures, and PCR on biopsy and gastric aspirate specimens.
- Treatment involved a standard 12-month anti-tuberculosis regimen.
Main Results:
- The patient presented with fever, cough, abdominal distention, hepatosplenomegaly, mediastinal lymphadenopathy, lung consolidation, and a retroperitoneal mass causing vertebral destruction.
- Diagnostic tests confirmed miliary TB and Pott's disease.
- The patient showed significant clinical improvement with anti-TB therapy, with complete symptom resolution except for kyphosis.
Conclusions:
- Miliary tuberculosis with Pott's abscess is a rare but serious complication of childhood TB.
- Prompt diagnosis and appropriate anti-TB treatment are crucial for favorable outcomes.
- Surgical correction, when necessary, can aid recovery without long-term sequelae.
Abstract:
A 20-month-old boy presented with 1-year history of persistent fever, cough, and progressive abdominal distention. Abdominal ultrasonography showed hepatomegaly and multiple calcifications in the liver and spleen. Thoracic computed tomography showed multiple mediastinal lymph nodes and consolidation in both lungs. Additionally, there was a 2-cm thick retroperitoneal soft tissue mass destroying the T7-8 and L1-L2 vertebral bodies. The patient was preliminarily diagnosed with miliary tuberculosis (TB) and Pott's disease, and began administering anti-TB treatment consisting of isoniazid, rifampin, ethambutol, and pyrazinamide. Acid-resistant bacilli analysis and mycobacterial culture of the biopsy specimen of Pott's abscess were positive. Mycobacterial culture and PCR of gastric aspirate were also positive. The patient's condition progressively improved with anti-TB treatment and he received 12 months of antiTB therapy. At the end of the treatment all of the patient's symptoms were relieved and he was well except for kyphosis. Miliary TB complicated by Pott's abscess is a very rare presentation of childhood TB. The presented case shows that when Pott's abscess is diagnosed and surgically corrected without delay, patients can recover without squeal.
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