Miliary tuberculosis and adult respiratory distress syndrome in an infant

We report on a 7 months old infant, who was admitted to our hospital with the tentative diagnosis of interstitial pneumonia. The infant was treated with erythromycin because of a positive mycoplasma antigen test in the nasopharyngical mucus and the radiological findings. A tension pneumothorax led to rapid respiratory deterioration and a severe ARDS developed. A sustained respiratory stabilization could not be achieved. The diagnosis miliary tuberculosis was detected on autopsy. A parenchymal focus was found subpleuraly in the left lung with a massive hematogenous spread and a tuberculous meningitis. The source of infection could not be identified in the family or in persons known to have had contact to the infant. The tuberculin skin test (PPD) was negative. Clinical, radiological and pathological findings are demonstrated.