Cavitary Pulmonary Tuberculosis in an Infant

Tuberculosis (TB) continues to pose a significant health challenge globally and in Portugal. Diagnostic challenges persist, especially in infants, where TB often presents with atypical symptoms. A previously healthy three-month-old male infant from Vila Nova de Famalicão, Portugal, was admitted with cough, rhinorrhea, respiratory distress, and high-grade fever. After chest radiography and blood tests, he was treated with ampicillin for community-acquired pneumonia (CAP). Initial antibiotic therapy proved ineffective, and subsequent imaging showed necrotizing pneumonia. Thoracic computed tomography and bronchoscopy revealed a significant consolidation with cavitation and lymphatic involvement, as well as extrinsic compression of the right main bronchus. Gastric aspirates (GA) and bronchoalveolar lavage (BAL) washings grew Mycobacterium tuberculosis. Treatment eventually with antituberculosis drugs and prednisolone resulted in clinical and radiological improvement. Subsequent immunological evaluations were normal.