An eleven-year-old boy presented to the emergency triage with complaints of fever, productive cough and breathlessness. Despite no significant past medical history, his sudden respiratory deterioration was alarming. Provisional diagnosis of bronchopneumonia was made and the child was shifted to Pediatric Intensive Care Unit (PICU) for closer monitoring and escalation of respiratory support. High Flow Nasal Cannula (HFNC) therapy was initiated, with monitoring using various indices. Oxygenation status and deteriorating chest imaging lead to a diagnosis of possible Pediatric Acute Respiratory Distress Syndrome. Refractory hypoxemia and unexplained right lower zone consolidation prompted bronchoscopy, which revealed a mucus plug obstructing the right lower lobe bronchus. Bronchoalveolar lavage tested positive for Mycobacterium Tuberculosis, confirming Endobronchial Tuberculosis. Immediate initiation of antitubercular therapy along with continued airway clearance led to significant clinical improvement, highlighting the importance of early suspicion and timely intervention in atypical presentations.
Kulal et al. (Sat,) studied this question.