HIV in Children
GRAND ROUNDS AND TEACHING FILES
Cavitatory Tuberculosis with Dissemination in a 5 months old child
Ira Shah
Consultant in Pediatric Infectious Diseases and Pediatric Hepatology, Nanavati Hospital, Mumbai, India
Incharge, Pediatric HIV and TB Clinic, B J Wadia Hospital for Children, Mumbai, India

A 5 month old female child was diagnosed as tuberculous meningitis (TBM) with cavitatory tuberculosis (TB). Cerebrospinal fluid (CSF) showed 159 cells/cumm (42 polymorphs, 117 lymphocytes) with sugar of 34 mg% and corresponding blood sugar of 109 mg% with elevated proteins 97.9 mg%. X-Ray Chest showed right upper zone cavity with consolidation and mantoux test was positive. Gastric lavage for acid fast bacillus was positive on smear. CT chest revealed multiple nodular opacities scattered all over lung parenchyma predominantly in basal and subpleural region. Right upper lobe showed a thick walled cavity associated with consolidation in the posterior segment. There were right hilar, paratracheal and posterior mediastinal lymphadenopathty present. CT brain revealed left frontoparietal hyper density which showed enhancement associated with effacement of cortical sulci suggestive of mass effect. She was treated with 4 drug antituberculous therapy (ATT) consisting of Isoniazid, Rifampicin, Pyrazinamide & Ethambutol along with steroids. HIV ELISA, lymphocyte subsets and serum immunoglobulins were normal. She did not respond to the therapy and parents took her home against medical advice.

Why did the child have cavitatory TB at 5 months of age?
See Previous Teaching Files
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Infection in Children - Part 2

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