Abstract
We report on a six-month-old infant admitted to our intensive care unit (ICU) with recurrent severe pneumonia. The mother was infected with human immunodeficiency virus (HIV)-infected, but initially failed to disclose this to doctors. Neither did she report the grandmother of the child’s chronic coughing, likely due to tuberculosis (TB). The infant was diagnosed with X-pert MTB/RIF® confirmed TB and tested positive for HIV infection. Once a correct diagnosis was established, the child demonstrated good recovery with appropriate TB and antiretroviral treatment (ART). The case demonstrates the importance of including TB in the differential diagnosis for young children not responding to first-line pneumonia treatment, especially in TB endemic areas. Taking a meticulous TB and HIV exposure history, with careful consideration of potential social stigma, is essential. It also demonstrates how the inaccessibility of HIV results and the absence of a continuous patient record may jeopardize patient care.
Highlights
We report on a six-month-old infant admitted to our intensive care unit (ICU) with recurrent severe pneumonia
We admitted a six-month-old girl to the Da Nang Hospital for Women and Children, a provincial referral hospital in central Viet Nam, with a diagnosis of recurrent severe pneumonia
There is increased awareness that children in human immunodeficiency virus (HIV)-affected households are at high risk of developing TB [2], this is often not the case in Asian countries like Viet Nam, where TB/HIV co-infection is less common than in sub-Saharan
Summary
We admitted a six-month-old girl to the Da Nang Hospital for Women and Children, a provincial referral hospital in central Viet Nam, with a diagnosis of recurrent severe pneumonia She was discharged from the same hospital two days earlier, but developed a fever with associated heavy breathing at home. In follow-up at the HIV clinic she showed good improvement, without new signs or symptoms suggestive of IRIS, with good weight gain (4.0 kg on discharge to 5.5 kg two months later) and the CD4 count increased to 1054 cells/ mm. The grandmother smoked ~20 cigarettes/day and had a productive cough with weight loss and malaise for many months Her private doctor suspected TB, but she refused to be tested at the clinic.
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