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[Miliary tuberculosis and adult respiratory distress syndrome in an infant]
M Krüger1, J Woenckhaus, R Berner
1Universitäts-Kinderklinik Freiburg.
Insights
A 7-month-old infant initially diagnosed with pneumonia developed severe acute respiratory distress syndrome (ARDS). Autopsy revealed miliary tuberculosis, highlighting diagnostic challenges in infants with negative tuberculin skin tests.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pulmonology
Background:
- Infants presenting with respiratory symptoms require careful differential diagnosis.
- Mycoplasma infections can mimic other respiratory illnesses in infants.
- Tuberculosis (TB) in infants can present atypically and pose diagnostic challenges.
Observation:
- A 7-month-old infant with suspected interstitial pneumonia and positive Mycoplasma antigen test was treated with erythromycin.
- The infant experienced rapid respiratory deterioration, developing tension pneumothorax and severe acute respiratory distress syndrome (ARDS).
- Despite intensive care, sustained respiratory stabilization was not achieved.
Findings:
- Autopsy confirmed miliary tuberculosis, with a subpleural parenchymal focus in the left lung and hematogenous spread.
- Tuberculous meningitis was also diagnosed.
- The source of infection remained unidentified, and the infant's tuberculin skin test (TST) was negative.
Implications:
- This case underscores the importance of considering miliary tuberculosis in infants with severe respiratory failure, even with negative TST.
- Diagnostic delays can occur when atypical presentations of childhood TB are not recognized.
- Improved diagnostic strategies for infant TB are crucial for timely and effective treatment.
Abstract:
We report on a 7 months old infant, who was admitted to our hospital with the tentative diagnosis of interstitial pneumonia. The infant was treated with erythromycin because of a positive mycoplasma antigen test in the nasopharyngeal mucus and the radiological findings. A tension pneumothorax led to rapid respiratory deterioration and a severe ARDS developed. A sustained respiratory stabilization could not be achieved. The diagnosis miliary tuberculosis was detected on autopsy. A parenchymal focus was found subpleurally in the left lung with a massive hematogenous spread and a tuberculous meningitis. The source of infection could not be identified in the family or in persons known to have had contact to the infant. The tuberculin skin test (PPD) was negative. Clinical, radiological and pathological findings are demonstrated.