A PEDIATRIC CASE OF MILIARY TUBERCULOSIS: RARE FINDINGS AND ATYPICAL COURSE

Authors

  • Carla Gomes Garcez Pediatric Department of Hospital de Braga
  • Susana Carvalho Pediatric Department of Hospital de Braga
  • Ana Antunes Pediatric Department of Hospital de Braga
  • Augusta Gonçalves Pediatric Department of Hospital de Braga
  • Carla Moreira Pediatric Department of Hospital de Braga
  • Henedina Antunes Pediatric Department of Hospital de Braga; Instituto de Investigação em Ciências da Vida e da Saúde (ICVS), Escola de Ciências da Saúde, Universidade do Minho e ICVS/3B’s - Laboratório Associado, Braga/Guimarães

DOI:

https://doi.org/10.25753/BirthGrowthMJ.v25.i3.10085

Keywords:

acid-fastbacilli, cerebral tuberculomas, persistent fever, tubercular choroiditis

Abstract

Bachground: Miliary tuberculosis results from lymphohematogenous dissemination of Mycobacterium tuberculosis and it’s a severe manifestation of the disease.

Case report: A nine-year old girl was admitted to our hospital with persistent fever. Acute miliary tuberculosis was diagnosed after chest radiography revealing diffuse, bilateral, small lung nodules, tubercular choroiditis in the right eye and positive acid-fast bacilli in gastric aspirate. Brain magnetic resonance imaging showed several small nodular lesions consistent with tuberculomas. Mycobacterium tuberculosis was identified in gastric aspirate cultures. Fever and positive acid-fast bacilli in gastric aspirate persisted after more than 40 days of therapy. It was excluded human immunodeficiency virus infection. No complications were reported. Later, clinical outcome was good.

Discussion: Tuberculosis remains a relevant diagnosis in children with prolonged fever. The classic image on chest radiography, tubercular choroiditis and the presence of acid-fast bacilli in gastric aspirate were essential in making a prompt diagnosis and appropriate implementation of therapy. It emphasized the importance of maintaining a high index of suspicion for a condition that is treatable.

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References

UpToDate.com [homepage na Internet]. Bernardo J MD.

Epidemiology and pathology of extrapulmonary and miliary

tuberculosis, 2014, [consultado em 2014 Agosto 15].

Disponível em:http://www.uptodate.com/.

Sharma SK, Mohan A, Sharma A, Mitra DK. Miliary

tuberculosis: new insights into an old disease. Lancet Infect

Dis. 2005;5:415–30.

Swaminathan S, Rekha B. Pediatric Tuberculosis: Global

Overview and Challenges. Clin Infect Dis. 2010;50: 184 -94.

UpToDate.com [homepage na Internet]. Bernardo J. Clinical

manifestations, diagnosis, and treatment of extrapulmonary

and miliary tuberculosis, 2014, [consultado em 2014 Agosto

. Disponível em:http://www.uptodate.com/

World Health Organization. Global tuberculosis control:

World Health Organization report. Wkly Epidemiol Rec.

;85: 69-80.

Direcção Geral de Saúde. Programa Nacional de Luta contra

a Tuberculose - Ponto da situação epidemiológico e de

desempenho, 2012 [consultado em 2014 Mar 16]. Disponível

em:http://www.dgsaude.pt.

Newton SM, Brent AJ, Anderson S, Whittaker E, Kampmann

B. Paediatric Tuberculosis. Lancet Infect Dis. 2008;8:498-510.

Guidance for national tuberculosis programmes on the

management of tuberculosis in children. Geneve, World

Health Organization 2006 (WHO/HTM/TB/2006.371).

UpToDate.com [homepage na Internet]. Palazzi DL. Etiologies

of fever of unknown origin in children, 2014, [consultado em

Agosto 15]. Disponível em:http://www.uptodate.com/.

UpToDate.com [homepage na Internet]. Leonard JM. Central

nervous system tuberculosis, 2014; [consultado em 2014

Agosto 15]. Disponível em:http://www.uptodate.com/.

UpToDate.com [homepage na Internet]. Adams LV, Starke

JR. Tuberculosis disease in children, 2014; [consultado em

Agosto 15]. Disponível em:http://www.uptodate.com/.

Cuevas LE, Browning R, Bossuyt P, Casenghi M, Cotton

MF, Cruz AT, et al. Evaluation of Tuberculosis Diagnostics in Children:

Methodological Issues for Conducting and

Reporting Research Evaluations of Tuberculosis Diagnostics

for Intrathoracic Tuberculosis in Children. Consensus from

an expert panel. Intrathoracic Tuberculosis Research in

Children. J Infect Dis. 2012: 1-7.

American Thoracic Society. Diagnostic Standards and

Classification of Tuberculosis in Adults and Children. Am J

Respir Crit Care Med. 2000;16:1376-95.

Trunz BB, Fine PEM, Dye C. Effect of BCG vaccination on

childhood tuberculous meningitis and miliary tuberculosis

worldwide: a metaanalysis and assessment of cost-eff

ectiveness. Lancet. 2006;367:1173-80.

Rodrigues LC, Diwan VK, Wheeler JG. Protective effect of

BCG against tuberculous meningitis and miliary tuberculosis:

a meta-analysis. Int J Epidemiol. 1993;22:1154-8.

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Published

2016-09-30

How to Cite

1.
Garcez CG, Carvalho S, Antunes A, Gonçalves A, Moreira C, Antunes H. A PEDIATRIC CASE OF MILIARY TUBERCULOSIS: RARE FINDINGS AND ATYPICAL COURSE. REVNEC [Internet]. 2016Sep.30 [cited 2024May13];25(3):182-6. Available from: https://revistas.rcaap.pt/nascercrescer/article/view/10085

Issue

Vol. 25 No. 3 (2016)

Section

Case Reports

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