The diagnostic challenges in a child with intestinal tuberculosis

Area of Science:

• Pediatrics
• Infectious Diseases
• Gastroenterology

Background:

• Tuberculosis (TB) presents a significant health challenge in Romania.
• Pulmonary TB is common, but intestinal TB is rare and often a diagnosis of exclusion, particularly in pediatric cases.
• This case highlights the diagnostic difficulties and management of intestinal TB in a child.

Observation:

• A 3-year-old boy presented with severe abdominal pain, melena, malnutrition, and edema.
• Initial investigations revealed anemia, low plasma proteins, inflammatory markers, and abnormal bowel imaging.
• Treatment with parenteral nutrition and antibiotics was ineffective.

Findings:

• The child's mother had a positive QuantiFERON® test and a chest X-ray suggestive of pulmonary TB.
• Bowel biopsy showed granulomas, and staining was positive for Mycobacterium tuberculosis.
• Initiation of specific anti-TB treatment led to significant clinical improvement, including resolution of symptoms and improved growth.

Implications:

• Intestinal TB can mimic other gastrointestinal conditions, posing a diagnostic challenge.
• A high index of suspicion is necessary for diagnosing intestinal TB, especially with atypical abdominal symptoms and no clear pulmonary signs.
• Prompt and accurate diagnosis is essential for effective management and favorable outcomes in pediatric intestinal TB.