Pulmonary tuberculosis reactivation in a 4-year-old boy on treatment for acute lymphoblastic leukemia: a case report and review of literature

Children undergoing chemotherapy for acute lymphoblastic leukemia (ALL) are at heightened risk for opportunistic infections due to immunosuppression, including reactivation of latent tuberculosis (TB). While pulmonary TB reactivation in pediatric oncology patients is rare, it poses significant diagnostic and therapeutic challenges in regions with high TB burden, such as Nigeria. We present the case of a 4-year-old boy undergoing maintenance therapy for ALL who developed recurrent fever, productive cough, weight loss, and drenching night sweats. Despite the absence of hemoptysis or respiratory distress, imaging revealed widespread reticular opacities and mediastinal lymphadenopathy. Laboratory tests reported leucopenia and elevated serum ferritin. Stool GeneXpert MTB/RIF testing confirmed the presence of Mycobacterium tuberculosis , enabling a diagnosis of pulmonary TB reactivation. The patient was commenced on standard anti-TB therapy and showed marked clinical improvement. Concurrent ALL maintenance therapy continued without significant adverse events or drug interactions. This case underscores the importance of proactive TB screening and tailored management in pediatric leukemia patients, especially in TB-endemic settings. Noninvasive diagnostic modalities such as stool GeneXpert MTB/RIF can be instrumental in early detection. Successful integration of anti-TB and chemotherapeutic regimens is feasible with careful monitoring, highlighting the need for clear guidelines on TB management in immunocompromised pediatric populations.