Miliary tuberculosis with positive acid-fast bacilli in a pediatric patient

Sao Paulo Medical Journal

Sara Regina Castanheira Fernandes¹  Marcia Noriko De Oliveira Homa¹  Aghata Igarashi¹  Andréa Luiza Mendes Salles¹  Ana Paula Jaloretto¹  Maria Silvia Freitas¹  Paulo Cesar Koch Nogueira¹ 

[1] ,Faculdade de Ciências Médicas de Santos Department of Pediatrics Santos,Brazil

关键词: Miliary tuberculosis;    Laboratory techniques and procedures;    Tuberculose miliar;    Técnicas e procedimentos de Laboratório;   

DOI  :  10.1590/S1516-31802003000300008

来源: SciELO

【 摘 要 】

CONTEXT: Tuberculosis is an important public health issue. The Brazilian government reported 78,460 new cases in 1999. Miliary tuberculosis is a severe form of this disease. OBJECTIVE: To report on an uncommon clinical presentation of miliary tuberculosis in a child. CASE REPORT: A 5-year old boy presented in the emergency room with fatigue and weight loss. He had had Staphylococcus aureus pneumonia 7 months before. Chest radiography revealed lobar consolidation and miliary pattern associated with small cavities in both upper lobes. Antibiotic therapy was started. The sputum was positive for acid-fast bacilli and hence the treatment recommended for tuberculosis (rifampicin, isoniazid [INH], pyrazinamide) was started. The patient was treated for 9 months and at the end of the follow-up period he had made a complete clinical recovery. CONCLUSION: Although in some particular cases sputum can be positive for acid-fast bacilli in children, limitations to the sputum test have forced pediatricians to base tuberculosis diagnosis on epidemiological data, clinical findings and radiographic pattern. In this particular case, we hypothesize that the sputum bacillus test was positive because bacilli grew inside residual pneumatoceles that were produced during previous pneumonia.

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