[Perinatal tuberculosis presenting as endobronchial tuberculosis diagnosed by bronchoscopy: a case report]

Area of Science:

• Pediatrics
• Infectious Diseases
• Pulmonology

Background:

• Infants with persistent respiratory symptoms can be challenging to diagnose.
• Pneumonia is a common initial misdiagnosis for various pediatric lung conditions.
• Endobronchial tuberculosis presents unique diagnostic and management challenges in neonates.

Purpose of the Study:

• To report a case of perinatal endobronchial tuberculosis in an infant.
• To highlight the diagnostic challenges and successful treatment of this rare condition.
• To emphasize the importance of considering tuberculosis in infants with refractory pneumonia.

Main Methods:

• Case presentation of a 3-month-old male infant with a 4-week history of cough.
• Diagnostic workup included chest CT, bronchoscopy with bronchoalveolar lavage, T-SPOT testing, and high-throughput sequencing.
• Treatment involved a multi-drug anti-tuberculosis regimen including isoniazid, rifampicin, pyrazinamide, and linezolid.

Main Results:

• Initial antibiotic therapy for presumed pneumonia was ineffective.
• Bronchoscopy revealed left main bronchus stenosis with granulomas and caseous necrosis.
• Diagnosis of *Mycobacterium tuberculosis* infection was confirmed by microbiological and molecular methods.
• One month of anti-tuberculosis treatment resulted in marked improvement in clinical symptoms and pulmonary imaging.

Conclusions:

• Perinatal endobronchial tuberculosis should be considered in infants with persistent, non-resolving pneumonia.
• Early and accurate diagnosis is crucial for effective management.
• A combination anti-tuberculosis regimen, including linezolid, can be effective in treating severe infant tuberculosis.