Pulmonary Tuberculosis Cavernoma in a Teenager Manifestating as Chronic Cough

Background: Chronic cough is a frequent cause of consultation in pediatrics. Most frequent causes are upper airway infections, post-nasal drips and asthma. Tuberculosis must be considered in the differential diagnosis.

Objective: To present a clinical case of TBC in a teenager.

Methods: Clinical case communication.

Results: A 13-years old girl, with infantile asthma, consulted because of persistent cough with asthenia in the last two months. Physical examination, including cardiopulmonary auscultation was normal. There were no abnormal findings in blood tests. Mantoux test resulted in induration of 20mm. The chest x-ray and lung- CT showed a pulmonary cavernoma (see images below). Empiric standar therapy was initiated, with isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB). Sputum microbiological cultures revealed growing of tuberculosis mycobacterium with resistance to isoniazid and mutation of InhA gen, so the directed antibiotic regimen consists on RIF, PZA and EMB for six months. In the contact tracing, her 15 years old sister was diagnosed as latent TBC infection.

Conclussion: Although TBC is not a frequent cause of chronic cough in our area, it must be ruled out with Mantoux and radiologic techniques. The contact tracing is very important to detect asymptomatic patients and stop the infection spreading.