Multiple tuberculomas and cavitating pulmonary tuberculosis in an infant

Area of Science:

• Pediatrics
• Infectious Diseases
• Neurology

Background:

• Tuberculosis (TB) remains a significant global health challenge, particularly in infants.
• The Bacillus Calmette-Guérin (BCG) vaccine offers some protection but does not prevent all forms of TB.
• Infant immune systems have lower cell-mediated immunity, increasing susceptibility to severe TB.

Observation:

• A five-month-old infant presented with prolonged fever and cough.
• The infant was diagnosed with severe pulmonary tuberculosis, including multiple tuberculomas and cavitation.
• Despite BCG vaccination and no known immunodeficiency, the infant had a household contact with active TB.

Findings:

• The infant developed multiple central nervous system (CNS) tuberculomas, a rare presentation.
• This case represents the youngest reported infant with multiple CNS tuberculomas.
• Dissemination to the CNS occurred early, bypassing typical timelines due to immature infant immunity.

Implications:

• Early diagnosis of CNS TB in infants is critical, often requiring neuroimaging.
• Infants are at high risk for severe TB and CNS involvement, irrespective of BCG status or absence of immunodeficiency.
• This case underscores the need for heightened awareness and diagnostic vigilance for infant TB, especially CNS TB.