Unusual Detection of Tuberculosis in a Woman with Down's Syndrome

Abstract

A woman with Down's syndrome (DS) had subfebrile temperature, nodular/patchy shadows on the chest X-ray over the right pulmonary base, and a history of recurrent respiratory infections. She was pale, asthenic, uncommunicative, mildly anemic and the erythrocyte sedimentation rate was 80/first hour. The tuberculin skin test (TST) PPD 3 was negative. Mycobacterium tuberculosis was isolated from oral mucosal brushing, sensitive to the first line anti-tuberculosis drugs. Patients with DS and other mental disabilities need special care and attention during diagnostic procedures for tuberculosis (TB).

Miliary tuberculosis presenting with acute respiratory distress syndrome in a patient with down syndrome

“…TB has been occasionally reported in patients with DS. Patients with chromosomal abnormalities such as DS may be at a higher risk of unusual forms of TB, mostly extrapulmonary with rare and serious complications 5,[14][15][16] .…”

“…An additional problem in reaching the diagnosis of miliary TB in individuals with DS is that in order to get adequate material for bacteriological analyses and depending on the level of their intellectual disability, diagnostic procedures have to be adjusted. In one documented case, an extremely poor general condition of a DS patient made it impossible for a sputum sample to be collected, so M. tuberculosis was isolated from oral mucosa brushing instead 16 . She was found to have negative AFB in induced sputum smear.…”