Abstract
Background: Tuberculosis (TB) is still causing deaths in children in TB endemic countries. Majority (80%) occur in the lungs, with 5% being miliary TB. It is an Interstitial Lung Disease (ILD) with similar clinical, physiological and radiological features to other ILD and affects mainly infants and children with a high mortality rate despite available treatment. Case Presentation: A three-month old male presented during the COVID-19 pandemic with fever of 2 weeks, cough of one week, fast and difficult breathing of 6 days’ duration. He received BCG vaccine 16 days after birth despite being unknowingly exposed to the TB contact from birth. He was acutely ill looking, with severe pneumonia and SPO2 of 76% in room air. Respiratory examination showed broncho vesicular breath sounds with no added sounds. A diagnosis of Severe pneumonia? Pneumocystis Jiroveci Pneumonia (PJP) and R/O COVID-19 was made. Subsequent reviews excluded PJP and COVID-19 and the final diagnosis was Disseminated (Miliary) TB. He was successfully treated with anti-TB medications for 12 months. Conclusion: Miliary TB presents with common and uncommon manifestations that may be confusing, and so a high index of suspicion with a careful history, focused systemic examination, imaging and bacteriological studies are strongly recommended for its early diagnosis.
Highlights
Tuberculosis (TB) is an old disease still causing deaths in children in developing countries and TB endemic regions [1,2,3] and yet childhood TB remains under-diagnosed and under-reported [2]
Miliary TB presents with common and uncommon manifestations that may be confusing, and so a high index of suspicion with a careful history, focused systemic examination, imaging and bacteriological studies are strongly recommended for its early diagnosis
Cite this article: Ewa AU, Bassey GE, Udoh UA, Akpah EU, Anachuna KC, et al Miliary Tuberculosis with Severe Pneumonia without Abnormal Chest Sounds in a Covid-19 Pandemic
Summary
Tuberculosis (TB) is an old disease still causing deaths in children in developing countries and TB endemic regions [1,2,3] and yet childhood TB remains under-diagnosed and under-reported [2]. The term miliary TB was formed in 1700 by John Jacob Manget from the word ‘miliarius’ which means “related to millet seed” and represents disseminated TB with miliary shadows on CXR [4] It has been a diagnosis of infants and children since the pre-antibioctic era [5] with a high mortality rate despite available treatment [4]. Majority (80%) occur in the lungs, with 5% being miliary TB It is an Interstitial Lung Disease (ILD) with similar clinical, physiological and radiological features to other ILD and affects mainly infants and children with a high mortality rate despite available treatment. Case Presentation: A three-month old male presented during the COVID-19 pandemic with fever of 2 weeks, cough of one week, fast and difficult breathing of 6 days’ duration He received BCG vaccine 16 days after birth despite being unknowingly exposed to the TB contact from birth. He was successfully treated with anti-TB medications for 12 months
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