Miliary Tuberculosis with Cutaneous Affectations and SARS-CoV-2 Coinfection in Infant: Case Report in Mexico

Abstract

Aims: To describe an infant presenting with miliary tuberculosis with cutaneous affectations and SARS-CoV-2 coinfection. Presentation of Case: 10 month old boy, with incomplete vaccination. Low Socio-economic status. The parents indicated, that lesion began with a single small, erythematous, non-pruritic, papule-type skin lesion on the left side of the infralabial region, with no other constitutional. During the following three months, the lesions became generalized. On June 23, 2020, he was admitted to the “Hospital para el Niño Poblano” in emergency area with mild malnutrition, lethargic state, fluid and electrolyte imbalance, metabolic acidosis, oral candidiasis, and septic shock, requiring endotracheal intubation. Besides, innumerable acid fast bacilli in skin biopsy and bronchial aspirate with diagnosis cutaneous TB was, identified. Immunodeficiency based on immunoglobulin profile and T and B cell markers. RT-PCR was performed for SARS-CoV-2 in bronchial aspirate, with a positive result. On June 25, 2020 died of cardiorespiratory arrest, secondary to septic shock and cutaneous tuberculosis. Discussion: Miliary TB in infants is difficult to diagnose in addition the cutaneous manifestation has added onto the long list of differentials, and downplay others, generating inappropriate and delayed treatment. Additionally, SARS-CoV-2 can intensify the clinical manifestations of miliary tuberculosis and directly influencing the mortality of this type of patients. Conclusion: The case described is rare, which reveals the importance to perform a differentiated diagnosis, considering Socio-economic and epidemiological context mainly in the first level of care. It is recommended to continue with research in order to generate information on the possible clinical pictures.