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Tuberculosis presenting as laryngeal stridor in a child
A C Elias-Jones1, J Sequeira, R N Leitch
1Hospital for Sick Children, London, U.K.
The Journal of Infection
|January 1, 1988
Summary
A child developed stridor after ear tube insertion, later diagnosed with laryngeal tuberculosis. Despite treatment, the condition progressed to central nervous system tuberculosis, leading to a fatal outcome.
Area of Science:
- Pediatric Otolaryngology
- Infectious Diseases
- Pulmonology
Background:
- Secretory otitis media is common in children and often treated with tympanostomy tubes (grommets).
- Stridor, a high-pitched breathing sound, can indicate upper airway obstruction.
- Laryngeal complications following grommet insertion are rare.
Observation:
- A 3.5-year-old boy presented with worsening stridor post-grommet insertion for bilateral secretory otitis media.
- Initial treatments including steroids, antibiotics, and antihistamines were ineffective.
- Microlaryngotracheobronchoscopy (MLB) revealed laryngeal granulations positive for acid-fast bacilli.
Findings:
- Culture from laryngeal granulations confirmed Mycobacterium tuberculosis.
- The child developed central nervous system (CNS) tuberculosis post-MLB, leading to coma.
- Despite chemotherapy, the patient died 8 days later; initial Mantoux and chest X-ray were negative, and CSF analysis was inconclusive.
Implications:
- This case highlights a rare but severe complication of Mycobacterium tuberculosis infection presenting as laryngeal disease after otitis media treatment.
- It underscores the importance of considering tuberculosis in pediatric stridor unresponsive to conventional therapies.
- Diagnostic challenges in pediatric CNS tuberculosis are evident, even with negative initial tests.