RT Journal Article
SR Electronic
T1 PO-0008 Pulmonary Tuberculosis In A 4 Month Old With No Respiratory Symptoms
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP A253
OP A254
DO 10.1136/archdischild-2014-307384.688
VO 99
IS Suppl 2
A1 S Osman
A1 A Hamad
A1 S Khan
A1 M Henduas
A1 S Elhassan
YR 2014
UL http://adc.bmj.com/content/99/Suppl_2/A253.3.abstract
AB Background Fever of unknown (FUO) origin often presents a unique diagnostic challenge to the paediatrician. We present a unique case of a 4 month old boy with fever for 1 month, who after extensive work up was diagnosed with pulmonary tuberculosis and Severe Combined Immunodeficiency (SCID). Case Report Our case is a 4 month old, Sudanese boy, residing in Qatar, who presented to our hospital with fever for two weeks. He remained febrile in the hospital for two weeks, despite receiving Intravenous antibiotics for presumed partially treated meningitis. He also received IVIG for the suspicion of atypical Kawasaki. Computerised tomography of the head and abdomen and bone marrow studies were also inconclusive. The mother subsequently revealed that a previous child had died during infancy with prolonged fever and no specific diagnosis. This alerted the treating physicians to the possibility of immunodeficiency. Our patient had received BCG vaccine at birth without any complications, and three gastric aspirate samples were negative for tuberculosis. A broncho-alveolar lavage was performed, despite the absence of any respiratory symptoms, to exclude any unusual organisms causing prolonged fever. The broncho-alveolar lavage revealed mycobacterium tuberculosis which was resistant to Isoniazid and the patient was started on appropriate anti-Tuberculous medications. The total immunoglobulin counts and Flow cytometry were suggestive of SCID. Conclusion Pulmonary Tuberculosis should be considered as a differential diagnosis of FUO, especially in infants with suspected or proven SCID. Attaining a good family history is crucial in early diagnosis of SCID and hence possibly in saving lives.