Zhu Jiarui, Chen Ning, Shang Yunxiao, Feng Yong
Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
Front Pediatr. 2023 Sep 1;11:1189838. doi: 10.3389/fped.2023.1189838. eCollection 2023.
Acute respiratory distress syndrome (ARDS) is a rare complication of miliary tuberculosis, particularly in pediatric patients. Comorbidities and delayed diagnosis can worsen the prognosis of patients with miliary tuberculosis. A 12-year-old girl presented with fever for 20 days, and cough and tachypnea for 4 days. She was diagnosed with miliary tuberculosis complicated by pediatric ARDS. She had atypical clinical manifestations and imaging findings, a negative contact history, and negative results of a tuberculin skin test (TST) and T-SPOT.. Diagnostic bronchoscopy and bronchoalveolar lavage helped make the diagnosis of tuberculosis. Effective treatment was promptly initiated after confirmation of the diagnosis, and the patient's condition improved. This case illustrates that a negative contact history and laboratory results cannot rule out tuberculosis. False-negative TST and T-SPOT. results should be evaluated carefully. Bronchoscopy may be useful for identifying pathogens in patients with pneumonia of unknown etiology, and corticosteroids should be administered with caution.
急性呼吸窘迫综合征（ARDS）是粟粒性肺结核的一种罕见并发症，尤其在儿科患者中。合并症和诊断延迟会使粟粒性肺结核患者的预后恶化。一名12岁女孩出现发热20天，咳嗽和呼吸急促4天。她被诊断为粟粒性肺结核并发儿科ARDS。她有非典型的临床表现和影像学表现，接触史阴性，结核菌素皮肤试验（TST）和T-SPOT结果均为阴性。诊断性支气管镜检查和支气管肺泡灌洗有助于确诊肺结核。确诊后立即开始有效治疗，患者病情好转。该病例表明，接触史阴性和实验室结果不能排除肺结核。应仔细评估TST和T-SPOT的假阴性结果。支气管镜检查可能有助于识别病因不明的肺炎患者的病原体，使用糖皮质激素时应谨慎。
