Introduction: Pulmonary tuberculosis (TB) still represents a serious public health problem. Young age and HIV infection constitute important risk factors for serious and systemic disease.
Case-report: We present the case of a 4-year-old boy with relevant priors of cerebral palsy, functionally totally dependent for activities of daily living. He was admitted for prolonged fever associated with a productive cough and dyspnea. He had been previously diagnosed with pneumonia and medicated with amoxicillin and clavulanic acid, having undergone therapy for 10 days, with no symptomatic improvement. When questioned, caretakers denied exposure to tuberculosis. Physical examination was compatible with septic shock in the context of pneumonia. X-ray supported the diagnostic hypothesis and showed a consolidation of the inferior lobe of the left lung. Therapy was instituted and the shock reversed. Afterwards, the patient had sustained fever and elevated values of sedimentation rate (SR), C-reactive protein (CRP) and transaminases. Antibiotics were escalated to ceftriaxone, clindamycin and vancomycin. There was no clinical improvement. The patient remained feverish and had radiological worsening on chest x-ray performed at the 13th day of internment. Chest tomography showed a miliary pattern on both lobes of the left lung. Mycobacterium tuberculosis was isolated on gastric aspirate. When confronted, caretakers finally admitted that there had previously been a member of the household infected with tuberculosis, but didn’t consider this as exposure “because the child was bedridden” (sic). Antitubercular and corticotherapy were instated, with significant clinical improvement.
Conclusion: TB in pediatric age continues to be a diagnostic challenge, especially when clinical presentation is atypical. Clinicians must be aware of the symptoms in order to make a prompt diagnosis, allowing early institution of proper therapy, decisive for prognosis.