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Infantile pulmonary tuberculosis: the great mimic

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Abstract

Purpose

Infantile tuberculosis is common in developing countries and rarely presents as space occupying thoracic lesions mimicking congenital malformations. This case series reviews four such infants with varied presentations and their outcome.

Methods

Four cases of infantile pulmonary/mediastinal tuberculosis that presented like congenital thoracic lesions are described. Details of demography, symptomatology, contact history, immunization status, provisional diagnosis, tuberculin testing, imaging, histopathology, final diagnosis, management and outcome were retrospectively collated and analyzed.

Results

They were 4–6-month males, term-born and immunized. They presented with pneumonia/hyperactive airway disease since 2–12 weeks. One had a suspect and another a close tuberculous contact. The provisional diagnosis after imaging were infected congenital lung cyst, posterior mediastinal cyst and bronchopulmonary malformation. Two were tuberculin positive; none had gastric acid-fast bacilli. One underwent a pulmonary lobectomy for necrotic lung cyst; the second had a biopsy and drainage of a posterior mediastinal cyst that contained caseating material and was densely adherent to the esophagus. Surgical biopsy showed necrotizing granulomatous inflammation in both; one with acid-fast bacilli. Both succumbed to postoperative complications. The other two with tuberculous contacts who were managed with early antituberculous therapy, responded well and recovered uneventfully.

Conclusions

Infantile pulmonary/mediastinal tuberculosis may mimic congenital thoracic malformations. A review of contact history, investigations and imaging help to establish the tuberculous etiology, avoids surgical misadventures and prompts early antituberculous therapy to achieve a favorable outcome.

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Authors and Affiliations

  1. Department of Paediatric Surgery, St.John’s Medical College Hospital, St.John’s National Academy of Health Sciences, Bangalore, 560034, India

    Roma Subhash Varik, Attibele Mahadevaiah Shubha & Kanishka Das

  2. Departments of Paediatrics, St.John’s Medical College Hospital, St.John’s National Academy of Health Sciences, Bangalore, 560034, India

    Maria Lewin

  3. Department of Pathology, St.John’s Medical College, St.John’s National Academy of Health Sciences, Bangalore, 560034, India

    Betty Alexander & Usha Kini

Authors
  1. Roma Subhash Varik
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  2. Attibele Mahadevaiah Shubha
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  3. Maria Lewin
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  4. Betty Alexander
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  5. Usha Kini
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  6. Kanishka Das
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Correspondence to Kanishka Das.

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Varik, R.S., Shubha, A.M., Lewin, M. et al. Infantile pulmonary tuberculosis: the great mimic. Pediatr Surg Int 28, 627–633 (2012). https://doi.org/10.1007/s00383-012-3084-8

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