Abstract:

Objective To report the diagnosis and treatment of a case of congenital drug-resistant tuberculosis combined with bronchial granuloma, thus summarizing the clinical experience and providing references for clinical management. Methods Clinical data of a child with congenital drug-resistant tuberculosis combined with bronchial granuloma admitted to our department on April 22, 2022 were analyzed, including the clinical characteristics, diagnosis and treatment. Results The child was prematurely, vaginally delivered at 34 weeks and 4 days of gestation, in an in vitro fertilization. At 40 days of age, the child developed symptoms of cough, wheezing, and fever, and repeatedly hospitalized for pneumonia. The mother of the child underwent in vitro artificial insemination due to tubal obstruction, and presented a history of obsolete pulmonary tuberculosis. Physical examination on admission showed rapid breathing, positivity for the Hoover's sign, slightly low respiratory sounds in the right lung, and wheezing sounds in both lungs. Lung CT showed multiple inflammatory consolidations and multiple nodules in both lungs, and extensive granulation tissue proliferation in bilateral bronchi on fiberoptic bronchoscopy. The tissue polymerase chain reaction for tuberculosis (TB-PCR) test showed positive Mycobacterium tuberculosis in the alveolar lavage fluid, and second-generation sequencing consistently showed Mycobacterium tuberculosis. The child was treated by oral rifampicin, isoniazid, and linezolid for antituberculosis therapy. One month after discharge, a follow-up lung CT and fiberoptic bronchoscopy showed disease progression. The rifampicin fluorescence quantitative nucleic acid amplification detection(X-pert MTB/RIF) assay indicated rifampicin resistance, and the child was then treated with a quadruple anti-tuberculosis therapy of levofloxacin, linezolid, pyrazinamide, and isoniazid. Fiberoptic bronchoscopy procedures, including granuloma electrocoagulation and resection, cryotherapy, and foreign body forceps extraction were performed for multiple times to relieve airway obstruction. The child had regular follow-up visits and underwent interventional therapy under fiberoptic bronchoscopy for nearly 7 months. At present, the child had a stable breathing, well-ventilated in both lungs, and no adverse drug reactions. The follow-up is ongoing. Conclusion Symptoms of congenital tuberculosis are atypical, and prone to a missed diagnosis. It is necessary to strengthen the application of fiberoptic bronchoscopy in the diagnosis and treatment of tuberculosis. Tubal blockage leading to infertility in women undergoing in vitro fertilization and embryo transfer may be the main cause of congenital tuberculosis. In addition, sputum Mycobacterium tuberculosis and drug resistance gene testing can guide clinical medication in patients with drug-resistant tuberculosis. However, there is currently limited guidance and treatment plans for drug-resistant tuberculosis in infants and young children, and the further research is needed.

Key words: tuberculosis, drug resistance, bronchial granuloma