Congenital Tuberculosis Complicated by Interstitial Pulmonary Emphysema
The present case report is about a 6-week-old female child who presented to the Department of Pediatric with difficulty in breathing since birth and progressively worsening cough since 15 days. The child was a preterm baby born at 34 weeks by normal vaginal delivery. There was a history of previous still birth. Prior to being hospitalized, and had received multiple antibiotics.\nOn further examination, the child was pale and malnourished. She had hepatosplenomegaly. She was tachypneic (Respiratory rate = 98/min), with severe subcostal and intercostal recessions. Respiratory system examination revealed decreased air entry and wide spread coarse crepitations. Her SpO2 was 86% with 100% oxygen inhalation by mask. Thus, she was put on ventilator. Investigations revealed: Hb 7.4 g%, total leukocyte count 10,500. Bacterial cultures of blood, cerebrospinal fluid and urine were negative. Her chest radiograph showed milliary mottling of both lungs. [] Ultrasonography showed hepatosplenomegaly with tiny hypoechoic nodules in spleen suggestive of granulomatous pathology. Montaux test was negative. Bronchial washings and gastric washings were negative for acid fast bacilli (AFB).\nThe child's mother was counseled and investigated for tuberculosis. There was no abnormality detected on chest radiograph of mother and her sputum was negative for AFB. However, the diagnosis of genital tuberculosis was confirmed by endometrial biopsy which was positive for AFB. Thus, the child and the mother both were put on anti-tuberculosis treatment.\nThe child remained on ventilatory support for 6 days and was put on bubble continuous positive airway pressure for the next 10 days. Thereafter, she showed respiratory distress whenever weaned from oxygen. Thus, she was put on oxygen inhalation by nasal prongs and remained oxygen dependent for 2 months. Computed tomography scan report showed multiple diffuse consolidations and thin walled cystic lesions in upper and middle lobes. [] The multiple cystic lesions were reported by the radiology department as interstitial pulmonary emphysema/tuberculous bullae; and were the explanation for air entrapment and prolonged oxygen dependence. Thus, the case was a unique case in which congenital tuberculosis, a rare entity itself was complicated by PIE, resulting in prolonged oxygen dependence. The child recovered slowly and was put off the oxygen inhalation by nasal prongs after 2 months. He was thus discharged in a satisfactory condition from the hospital after 2.5 months. On follow-up visit to the outpatient department after 2 weeks, there was marked clinical improvement. Repeat chest radiograph and ultrasonography showed clearing of tuberculous lesions.