Aim To analyze the agreement between tuberculin skin test (TST) and fourth-generation QuantiFERON (QFT)-TB Gold Plus [interferon gamma (INF-γ) release assays (IGRA)] for latent tuberculosis infection (LTBI) diagnosis among under-five children who are undernourished and/or who have history of contact with active tuberculosis (TB) patients. Methods Children from the age group of 6 months to 5 years (undernourished or tuberculosis household contacts) were screened through anganwadis (government playschools) and TB Health posts from Mumbai, India during September 2019 to January 2021. Both TST and QFT-TB Gold Plus test were carried out to diagnose LTBI. Results Out of the total 299, 35 (11.7%) (95% CI 8.1–15.3%) children tested positive by IGRA (QFT-TB Gold Plus) and 68 (22.7%) (95% CI 18.0–27.4%) by TST, suggestive of moderate concordance (κ = 0.483) between both tests. IGRA and TST showed moderate concordance in children <24 months (κ = 0.478). Moreover, 26 (21.1%) children with TB contact had both TST and IGRA positive with moderate concordance (κ = 0.550). A fair concordance (κ = 0.396) was observed between IGRA and TST in undernourished children. Also, 45 (15.0%) children showed discordance of which 39 (13.0%) had positive TST but negative IGRA and 6 (2.0%) had negative TST but positive IGRA. Conclusions The study strongly recommends both TST and QFT-TB Gold Plus test for the diagnosis of LTBI in under-five children. A moderate concordance in children <24 months endorses the reliability of QFT-TB Gold Plus in diagnosing LTBI in this age group. This study highlights the need for screening undernourished children for LTBI to consider repeating IGRA testing for TST positives as per the window period and risk of ongoing exposure.

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for management of his multidrug-resistant (MDR) pulmonary tuberculosis (PTB) with left sided pleural effusion. Sputum microscopy and GeneXpert were positive for acid fast bacilli (AFB) (2+) and rifampicin resistant Mycobacterium tuberculosis (MTB) respectively. He was started on kanamycin (Km), high dose moxifloxacin (Mfx), para-aminosalicylic acid (PAS), cycloserine (Cs) and clofazimine (Cfz) as secondline anti-tubercular treatment (ATT) regime. In June 2018, he had hemoptysis for 4 d. His hemoglobin dropped from 8.4 g/dl to 6.1 g/dl. He was immediately hospitalised, transfused with packed red blood cell (PRBC) transfusion and underwent an urgent contrast enhanced CT chest (CECT) with pulmonary angiography, which revealed destruction of entire left lung parenchyma with bronchiectasis, areas of necrotic breakdown in the left lower lobe with a large 1.9 × 2.0 cm sized Rasmussen's aneurysm. On the same day, he expectorated 120 ml of frank blood for which he received PRBC transfusion again. He underwent transcatheter intra-aneurysmal glue embolization of the Rasmussen's aneurysm under general anesthesia. He had no further episodes of hemoptysis. He was observed for one week and then discharged.Hemoptysis is estimated to occur in fewer than 1% children with PTB [1]. Hemoptysis in TB could be due to various etiologies like aspergillomas, broncholiths, bronchiectasis, chronic bronchitis, TB reactivation, scar carcinoma, microbial colonization within a cavity and vascular abnormalities such as pseudoaneurysms [2]. Rasmussen's aneurysm is an extremely rare entity with a prevalence of 4% in autopsy findings of chronic cavitary TB [3]. It results from the weakening of the pulmonary artery wall from an adjacent cavity, leading to pseudoaneurysm formation [4]. It may lead to rupture and life-threatening massive hemoptysis with a mortality rate ranging from 50 to 100% [5]. Our patient also had a large quantity of hemoptysis but timely intervention proved to be lifesaving. CT in a child with hemoptysis is diagnostic and should be done using an injector and bolus tracking technique with timing of contrast injection being crucial for opacification of either the pulmonary artery/bronchial circulation. Hemoptysis is now increasingly being managed through trans-arterial catheter embolization procedures, performed by interventional radiologists which is also the first-line of therapy.

We report a case of 10 months old child with a variant of Goldenhar syndrome in the form of microtia of right ear, microsomia of the right-side face, right facial nerve palsy with cardiac anomaly, renal anomaly and sensorineural hearing loss on the right side which were rare associations prompted to report this case.

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