Miliary TB with pelvic mass and choroidal tubercles in a child: Case report

摘要

Miliary Tuberculosis (TB) is a fatal form of disseminated TB. In childhood it remains a significant health problem in the developing countries. The most common type of TB disease in children is pulmonary TB. While, extra pulmonary TB occurs in approximately 20–30% of all cases in children. Miliary TB accounts for ～1% of all TB cases.We reported a case of pediatric miliary TB in a seven years old female presented with fever associated with sweating, decreased appetite and weight loss. Clinical examination showed hepatospenomegaly and pelviabdominal mass. Laboratory studies revealed anemia and elevated erythrocyte sedimentation rate (ESR) for differential diagnosis. Malignancy was suspected and a panel of radiological scans and histopathological study were done to investigate the mass and to search for other masses elsewhere. The bone marrow and the pelviabdominal mass biopsies were done, and showed normal bone marrow while the mass appeared to be TB granuloma. Tuberculin test, gastric lavage for Ziehl-Neelsen stain (ZN) study for acid-fast bacilli, and Polymerase chain reaction (PCR) test for mycobacterium TB DNA in blood were negative. The ophthalmological screening before commencing anti TB regimen revealed fundus with bilateral small, white sub retinal opacities with the classical appearance of choroidal tubercles. The final diagnosis of miliary TB was made and the patient subsequently started her anti TB therapy in the chest hospital. Conclusion Keeping in mind its protean manifestations, miliary TB should always be considered in the differential diagnosis of the pelvic tumors, especially in the regions that are endemic for the disease.