Am. J. Trop. Med. Hyg., 80(3), 2009, pp. 325
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene
Air Leak in Miliary Tuberculosis
Benjamin D. Lakin,
F.A.I. Riordan, AND
Cheri Mathews John*
Department of Paediatrics, Whiston Hospital, Prescot, Merseyside, United Kingdom; Department of Infectious Diseases, Royal Liverpool Children’s Hospital, Liverpool, United Kingdom
A 4-year-old white boy presented with a 2-week history of non-productive cough, fever, and malaise. There was no history of contact with tuberculosis. He was tachypneic and had bilateral crepitations. A plain chest radiograph showed miliary shadowing (Figure 1
). Over the next 36 hours, he continued to deteriorate, with increasing respiratory distress and oxygen requirements. A Mantoux test was negative. An interferon-
release assay (Quantiferon Gold) was positive. His continued deterioration necessitated mechanical ventilation. Subsequently, he developed a pneumothorax and subcutaneous emphysema complicating ventilation ( Figure 2 ). He was managed with high-frequency oscillation ventilation, NO, and chest drain placement. Extracorporeal membrane oxygenation (ECMO) was considered but not required. He was treated with anti-tuberculous therapy with corticosteroids. Sputum culture grew fully sensitive Mycobacterium tuberculosis. He completed a 6-month course of anti-tuberculous treatment and became completely asymptomatic. Contact tracing did not identify the source of his tuberculosis.
This case highlights an unusual complication, although air leaks are described.1 It highlights the need to be vigilant for tuberculosis even in low-risk individuals in low-risk countries. Our experience also highlights that the Mantoux test may be negative in miliary tuberculosis, as recently reviewed.2
Received December 7, 2008.
Accepted for publication December 14, 2008.
* Address correspondence to Cheri Mathews John, Consultant Pediatrician, Department of Paediatrics, Whiston Hospital, Warrington Road, Prescot, Merseyside L35 5DR, UK. E-mail: cheri.john{at}sthk.nhs.uk 
Authors’ addresses: Benjamin D. Lakin and Cheri Mathews John, Whiston Hospital, Department of Pediatrics, Liverpool, Merseyside, UK, Tel: 00441514301754, Fax: 00441514301902, E-mail: benjaminlakin{at}hotmail.com and cherijohn25{at}hotmail.com. Andrew Riordan, Royal Liverpool Children’s Hospital, Division of Infectious Diseases, Liverpool, Merseyside, UK, E-mail: Andrew.Riordan{at}alderhey.nhs.uk.
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