Diagnostic Dilemma

HIV and TB


Author: Pediatric Oncall
Question
A 5 years old boy was detected to have endobronchial TB at the age of 2 years and was on antituberculous therapy {ATT} for the past 3 years that included intermittent Streptomycin and Amikacin injections. Currently, he now had pneumonia along with otitis media and molluscum contagiosum. Thus an HIV ELISA was done which was positive. CD4 count was 509 {23 percent} cells/cumm. Both parents were also subsequently screened and were also HIV infected. A CT chest was done that showed multiple minimally enlarged non-necrotic axillary lymph nodes with necrotic enlarged subcarinal lymph node {2.5 x 1.9 cm} with patchy consolidation in the posterior segment of the right upper lobe with collapse consolidation. Nodules were seen in the apicoposterior segment of left upper lobe, the superior segment of left lower lobe and right lower lobe showing the endobronchial spread of disease. The child was started on first line ATT as well as ART and bronchoalveolar lavage {BAL} was sent for TB Bactec culture. The patient was subsequently lost to follow up for the next 6 months. He again presented with molluscum and chest X-Ray showed the same picture.

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