Intra‐thoracic tuberculosis lymphadenitis in a child with rheumatic heart disease

Abstract

A 17-year-old boy presented with a 1 month history of intermittent fever, together with loss of appetite and weight loss of more than 10% (103-89 kg) over the preceding 3 months. No localising symptoms were reported. He reported no sick contacts, no contact with animals, and no recent local or overseas travel. He was fully vaccinated. He had a background of rheumatic heart disease (RHD) with severe aortic regurgitation that required prosthetic aortic valve replacement and mitral valve annuloplasty 3 years prior. He was on monthly benzathine penicillin prophylaxis and warfarin with good adherence. He was of Samoan ethnicity, lived at home with his parents, one brother and two sisters and was well supported by a large extended family.On clinical examination he was alert, but looked pale and non-acutely unwell. He was febrile with a temperature of 39 C but hemodynamically stable with mild tachycardia (heart rate 106/min, blood pressure 114/72 mmHg and oxygen saturation 98% in room air). No lymphadenopathy or clubbing was noted, nor stigmata of infective endocarditis. His chest examination