Endobronchial tuberculosis in infants: the importance of early diagnosis

Abstract

Introduction: endobronchial tuberculosis is the most frequent complication of pulmonary tuberculosis in children. The diagnosis is difficult and it requires a high level of suspicion. The clinical and radiological features are nonspecific, and it is confused with pneumonia, asthma, foreign body and tumor. The treatment is the same as pulmonary tuberculosis, but the include of corticosteroid is still controversial. Objective: to report endobronchial tuberculosis in an infant, with an excellent response to the specific treatment associated to corticosteroid. Case description: boy, 4 months, hospitalized for
pneumonia, without improvement after antimicrobial schedules. His stepfather was treating pulmonary tuberculosis. His mother, drug user, with untreated pleural tuberculosis, evolved to death at the time of the infant’s hospitalization. He was transferred to university hospital. At admission there were clinical-radiological disagreement, tachypneic, dyspneic, diffuse wheezing and rales. Chest X-Ray: same image of the hospital of origin. Chest HRCT: LSD atelectasis and mediastinal lymphadenopathy. Hemogram: anemia and leukocytosis with predominance of polymorphonuclear. High PCR. Bronchoscopy: extrinsic compression and caseum in BLSD. Culture of bronchoalveolar lavage with Mycobacterium tuberculosis. Discussion: the history of pneumonia non-responsive to treatment associated to family contact with tuberculosis and clinical radiological discordance lead to the diagnosis of pulmonary tuberculosis, corroborated by the MS scoring sys
tem. Airway compression have been suspected in cases of coughing,
wheezing, pneumonia not responsive, mediastinal lymphadenopathy,
hyperinflation and pulmonary atelectasis. Clinical, radiological, tomo
graphic and bronchoscopic signs of bronchial obstruction suggested
endobronchial tuberculosis. Corticosteroid was associated to the the
rapeutic antituberculosis getting complete resolution.