A previously healthy 8-year-old girl was presented with a 3-month history of a dry cough and persistent fever. A chest radiograph (Panel A) and CT scan (Panel B) were acquired. A tuberculin skin test and an interferon release assay were positive but sputum acid-fast bacilli smear was negative. Sputum and bronchoalveolar lavage, and CSF samples were obtained for the culture test. During the waiting period for culture results, empirical first-line treatment for tuberculosis was initiated. However, the patient's condition did not improve after 2 months of therapy.
The cultures came negative. Lung biopsy was performed and H&E stains showed caseous necrosis and the acid-fast stain was positive for bacilli (Panel C). Do you think, this is a case of drug-resistant tuberculosis? *This case is from Docplexus editorial team for the educative purpose only. Source: NEJM Stay Connected, the answer…
