7-month old new immigrant girl from China
(by Lee, So-Lun and Yeung, Chap-Yung)

Presenting Features:
  Repeated episodes (5x) of fever for 2-3 days in past
    3 months, with apparent response to short courses of treatment.
  Associated productive cough in recent 2 episodes.
   
Background:
  Mother been treated for TB 3 years ago.
  Infant had been given BCG at birth.
   
When seen in Sept 1999:
 
Fig.1A Fig. 1B
Click to Enlarge
Complete collapse of left lung with shifted mediastinum,
but infant only minimally dyspneic (Fig. 1A)
   
Relvant Investigations & Procedures:
 
Bronchoscopy revealed yellowish granulation tissue
    obliterating left main bronchus, anticipatory
    foreign body not found. (Fig. 2)


Fig. 2
Click to Enlarge

Suctioning resulted in re-opening of left lung (Fig. 1B)
BAL yielded AFB and culture positive for TB





   
Diagnosis:
  Endobronchial Tuberculosis
   
Distinctive Features:
 
  1. Young infant with non-primary pulmonary TB (endobronchial)
  2. Sputum-positive / open TB, therefore could be "infectious" to others
  3. Similar sputum-positive cases have been seen in a number of Chinese infants and small children
Author's Hypotheses:
 
  1. This is a post- primary pulmonary tuberculosis - with endobronchial disease.
  2. B.C.G. at birth togather with repeated early exposures to T.B. organisms through over-crowding living conditions, traditional feeding habits which tend to enhance droplet-spread diseases, or over-powering number of invading organisms may have contributed to the pathology.
  3. Sub-nutritrion may play a role.