Bronchial Obstruction Caused by Pulmonary Tuberculosis in 3 Months Baby

Introduction: Tuberculosis remains an important cause of morbidity and mortality in children worldwide. Diagnosing the pulmonary tuberculosis can be challenging in infants and young children since clinical and radiological signs can be non-specific.

Purpose: The main purpose of this case report is to highlight the challenge of diagnosing tuberculosis in young children.

Materials and Methods: We present the case of a 3 months baby, admitted in Pediatrics Department of “Grigore Alexandrescu” Hospital in October 2018 for rhinorrhea and fever.

Case Description: A previously healthy 3-months-old male was brought to the emergency department due to rhinorrhea in the previous 10 days and fever in the admission day. At the clinical examination, he had a good general appearance, rhinorrhea, spastic cough and symmetric breathing sounds in the pulmonary auscultation. The blood analysis revealed elevated platelets count and C-reactive protein with anemia. The chest radiography showed a density in the left upper lobe. Given this workup, the patient was diagnosed with Pneumonia, admitted and treated with Ceftriaxone. Fever persisted during the first 10 days of hospital stay. At the insistent resumption of the anamnesis, we found out that the father was hospitalized about 2 years ago for Tuberculous Pleurisy. A bronchoscopy was performed, revealing stricture in the area of left upper bronchus. The lung computer tomography confirmed the upper left atelectasis and several hilar and mediastinal adenopathies that amputated the left main bronchus. The baby and his mother started anti-tuberculosis treatment with good clinical evolution.

Conclusion: Primary pulmonary tuberculosis in childhood is a difficult diagnose to make. Radiographic features, even if it may compress the trachea or main bronchus causing external stenosis, can be misleading. Rethinking the case and inclusion of the anamnestic data can lead to early diagnosis and appropriate treatment, therefore avoiding disastrous consequences.