Disseminated Tuberculosis Involving Lungs, Bronchus, Abdominal Cavity, Intracalvarium, and Spinal Column

To the Editor, An 11-year-old, previously healthy girl was admitted to the hospital because of 2 weeks of recurrent fever, cough, abdominal pain, lower back pain and headache. A contrast computed tomography scan of the chest revealed bilateral diffuse opacities (Figure 1A, black arrows) and small calcification in the mediastinal lymph node (Figure 1B, white arrows). Ultrasonographic examination of the abdomen revealed multiple peritoneal nodules and swelling of the intestinal walls. Magnetic resonance imaging studies of the spine and head showed osteoclasia of the fourth lumbar vertebrae and paravertebral abscess (Figure 2), and an abscess in the left parietal lobe (Figure 3). Sputum, bronchoalveolar lavage and gastric fluid cultures grew Mycobacterium tuberculosis. A diagnosis of disseminated tuberculosis of the lungs, abdominal cavity, intracalvarium and vertebrae was made. With antituberculosis treatment she gradually became afebrile, and cough and pain resolved. Subsequently, her mother was diagnosed as tuberculous pleurisy. Tuberculosis is still one of the major infectious diseases in the world. Eight countries, including China, have two thirds of the global total of tuberculosis cases [1]. Nonspecific symptoms of tuberculosis and the low positive rate of sputum smear make the diagnosis difficult. Macro nodules and patchy opacities are seldom in children tuberculosis cases, which make the diagnosis even more difficult; so further investigations for differential diagnosis are needed. Disseminated TB is commonly associated with immune-compromised state [2]. This severe presentation with multifocal involvement in an immunocompetent patient may have been prevented with BCG vaccination. BCG vaccination is a highly cost-effective intervention against severe childhood tuberculosis; it should be retained in high-incidence countries [3]. Hao Wang: data curation, software, writing–original draft, visualization, writing–review and editing. Bao-ping Xu: methodology, investigation, writing–review and editing. Kun-ling Shen: supervision, conceptualization, writing–review and editing. All authors gave final approval and agreed to be accountable for all aspects of the work. This study has been approved by Ethical Committee of Beijing Children's Hospital (ethical approval number: [2023]-E-111-R). The study received an exemption from informed consent. It is a retrospective study; it does not involve additional blood tests for children and does not increase additional risks for children. Only clinical data of the patient are collected, and the real identity information of children is erased and deidentified during statistics, and it does not involve disclosure of children's privacy and biological samples. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request. The article did not generate any research data.