Diagnostic and treatment challenges of tuberculosis in a 12 year old boy

Background: Empyema thoracis may occur from parapneumonic pleural effusion and is associated with prolonged respiratory symptoms requiring longer times for drainage. Suppurative bacterial infections and tuberculosis are important causes; which if not treated early, may result to chronic empyema requiring thoracotomy and decortication. Objectives: To highlight the diagnostic and treatment challenges in a child with pleural effusion, which progressed to chronic empyema thoracis requiring decortication. Case report: 12 year old boy with fever, cough and weight loss of 3 weeks and left sided chest pain of 1 week. Respiratory examination and chest radiograph findings were in keeping with left sided pleural effusion, and left lobar pneumonia was considered. Pleural aspirate yielded Pseudomona aeruginosa. Despite treatment with several antibiotics and chest tube drainage, patient developed persistent empyema thoracis which subsequently warranted left sided thoracotomy and decortication. Though initial investigations for pulmonary tuberculosis (PTB) including gene expert were all negative, pleural peel decortications sample revealed histologic features of tuberculosis. He was therefore commenced on anti-tuberculous medications and showed significant clinical improvement. Conclusion: Empyema thoracis complicating tuberculosis may occasionally require decortication. Diagnosis of the underlying PTB infection can be difficult, resulting in delayed treatment and increased morbidity. Correspondence to: Dr. Bilkisu Garba Ilah, Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, E-mail: [email protected]