A seven-year-old girl born in Spain with no previous pathology was referred to the Pediatric Infectious Diseases Unit due to painful left submandibular lymphadenopathies of one month evolution, with no response to treatment with amoxicillin.
The patient had no fever, night sweats or weight loss.
He wasn't vaccinated with BCG.
During one month a year visit to Morocco, where she has contact with animals (ewes, lambs) and consumes unpasteurized dairy products.
The physical examination revealed a left submandibular conglomerate of lymphadenopathies, painless to palpation anamnesis, hard, non-wheeled or attached, the largest of the adenopathies measuring 2 × 2 cm. The rest of the pathological findings
Given the lack of response to treatment and taking into account epidemiological data, the tuberculin test was performed, which was positive, with an induration of 10 mm with vesicular pattern at 72 hours.
Chest X-ray and abdominal ultrasound were normal.
1.
Brucella serology, Epstein&#146;s anomaly (VEB) and cytomegalovirus (CMV) were negative.
Laboratory tests showed normal blood count, erythrocyte sedimentation rate (GSR) of 47 mm/hour and interferon-gamma release assays (IGRA) (QuantiFERON(r) value: 0.150.35).
A needle aspiration biopsy (FNAB) of the adenopathy showed a whitish thick material.
Culture and cytological study revealed a pattern of necrotizing granulomatous lymphadenitis.
Given the scarce affectation of the patient and the suspicion of tuberculous adenitis, an initial home treatment with isoniazid, rifampicin and pyrazinamide was initiated, waiting for the culture of the sample obtained by FNAB.
The culture was positive for M. bovis, presenting an antibiogram with pyrazinamide resistance and sensitivity to streptomycin, etambuco, isoniazid and rifampicin.
Pyrazinamide was prescribed for this reason during two months, followed by isoniazid and rifampicin for six months.
Mycobacterium cultures in gastric juices were negative.
During this time the patient went to periodic reviews in the Pediatric Infectious Diseases Department, in which a good clinical evolution and complete resolution of the infectious process were observed.
