[Miliary tuberculosis and adult respiratory distress syndrome in an infant]

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Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
06:15

Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus

Published on: March 6, 2019

M Krüger1, J Woenckhaus, R Berner

  • 1Universitäts-Kinderklinik Freiburg.

Klinische Padiatrie
|January 1, 1999
PubMed

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.

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