Senanayake M P, Mettananda S, De Silva M V C
Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
Ann Trop Paediatr. 2011;31(4):357-61. doi: 10.1179/1465328111Y.0000000041.
A 4-month-old infant presented with continued fever, unresolving bronchopneumonia and household contact with sputum-smear-positive tuberculosis (TB) and showed marginal improvement on anti-TB chemotherapy. Recurrent pneumothorax prompted the clinical diagnosis of TB to be revised. High-resolution CT scan of the chest and open lung biopsy confirmed the diagnosis of pulmonary Langerhans cell histiocytosis. Treatment with prednisolone and vinblastin resulted in settling of fever and resolution of respiratory symptoms and signs. In communities where the prevalence of TB is high, unusual presentations should prompt consideration of alternative diagnoses.
一名4个月大的婴儿出现持续发热、未愈的支气管肺炎，且有痰涂片阳性肺结核（TB）的家庭接触史，抗结核化疗后病情仅略有改善。反复气胸促使对结核病的临床诊断进行修正。胸部高分辨率CT扫描和开胸肺活检确诊为肺朗格汉斯细胞组织细胞增多症。泼尼松龙和长春花碱治疗后发热消退，呼吸道症状和体征缓解。在结核病高发社区，不寻常的表现应促使考虑其他诊断。
