BACKGROUND: We report a 1-month-old infant admitted with fever, dyspnea, and desaturation after an unmonitored pregnancy in a migrant family. The patient rapidly required mechanical ventilation. Laboratory parameters were markedly elevated, suggesting an infectious etiology. METHODS: The clinical course is described with emphasis on diagnostic challenges, including imaging, laboratory findings, and the stepwise process of differential diagnosis. RESULTS: After common etiologies were excluded, rarer causes were considered. The final diagnosis was established through integration of clinical assessment, radiological imaging, laboratory data, and microbiological testing. CONCLUSION: In neonates with fever and respiratory distress, RSV bronchiolitis is usually the first consideration. If excluded, clinicians must remain alert to less frequent etiologies. This case underscores the importance of a broad differential diagnosis in infants with acute respiratory compromise.

Clinic of Paediatrics of the 1st Faculty of Medicine Thomayer University Hospital Charles University Prague Czech Republic

Department of children's infectious diseases The University Hospital Brno Brno Czech Republic

Department of Paediatric Anaesthesiology and Intensive Care Medicine University Hospital Brno and Faculty of medicine Masaryk University Brno Czech Republic

Department of Pediatric Intensive Care Thomayer University Hospital Prague Czech Republic

Department of Pulmology Hospital Uherské Hradiště Uherské Hradiště Czech Republic

Department of Respiratory Medicine 1st Faculty of Medicine Charles University and Thomayer University Hospital Prague Czech Republic

Laboratory for Mycobacteria Ifcor Clinical Laboratories Ltd Brno Czech Republic

Zobrazit více v PubMed

Schaaf H. S., Bekker A., and Rabie H., “Perinatal Tuberculosis—An Approach to an Under‐Recognized Diagnosis,” Frontiers in Public Health 11 (2023): 1239734, 10.3389/FPUBH.2023.1239734. PubMed DOI PMC

Skevaki C. L. and Kafetzis D. A., “Tuberculosis in Neonates and Infants: Epidemiology, Pathogenesis, Clinical Manifestations, Diagnosis, and Management Issues,” Pediatric Drugs 7, no. 4 (2005): 219–234, 10.2165/00148581-200507040-00002. PubMed DOI

Lee J. S., Lim C. H., Kim E., et al., “Congenital Miliary Tuberculosis in an 18‐Day‐Old Boy,” supplement, Korean Journal of Pediatrics 59, no. Suppl 1 (2016): S64, 10.3345/KJP.2016.59.11.S64. PubMed DOI PMC

Doležalová K., Křepela K., Pohl J., Koťátko P., Svobodová T., and Houšťková H., “Acute Miliary Tuberculosis in a Infant,” Pediatrics for Practise 10, no. 6 (2009): 397–400.

Doležalová K., Kika V., Göpfertová D., and Wallenfels J., “Trends in Incidence of Extrapulmonary Tuberculosis in Children in the Czech Republic in the Past 35 Years,” Central European Journal of Public Health 30, no. 4 (2022): 207–212, 10.21101/CEJPH.A7499. PubMed DOI

Buonsenso D., Mariani F., Morello R., and Song R., “State‐of‐the‐Art of Miliary Tuberculosis in Children: Protocol for a Scoping Review of the Literature,” F1000Research 12 (2023): 309, 10.12688/f1000research.132068.1. DOI

Colditz G. A., Brewer T. F., Berkey C. S., et al., “Efficacy of BCG Vaccine in the Prevention of Tuberculosis: Meta‐Analysis of the Published Literature,” Journal of the American Medical Association 271 (1994): 698, 10.1001/jama.1994.03510330076038. PubMed DOI

Trunz B. B., Fine P., and Dye C., “Effect of BCG Vaccination on Childhood Tuberculous Meningitis and Miliary Tuberculosis Worldwide: A Meta‐Analysis and Assessment of Cost‐Effectiveness,” Lancet 367 (2006): 1173–1180, 10.1016/S0140-6736(06)68507-3. PubMed DOI

de Vries G., Guthmann J. P., Häcker B., et al., “TB Among Refugees From Ukraine in European Countries,” IJTLD OPEN 1, no. 4 (2024): 166–173, 10.5588/IJTLDOPEN.24.0062. PubMed DOI PMC

“WHO OPerational Handbook on Tuberculosis: Module 5: Management Of Tuberculosis in Children And Adolescents,” WHO, accessed September 27, 2023, https://www.who.int/publications/i/item/9789240046832.

Breen R. A. M., Smith C. J., Bettinson H., et al., “Paradoxical Reactions During Tuberculosis Treatment in Patients With and Without HIV Co‐Infection,” Thorax 59, no. 8 (2004): 704–707, 10.1136/THX.2003.019224. PubMed DOI PMC

Gupta A., Srivastava V. K., Khanna V. N., and Rizvi I., “Paradoxical Reaction to Antitubercular Therapy in Miliary Tuberculosis,” BMJ Case Reports 2012 (2012): bcr0320126142, 10.1136/BCR-03-2012-6142. PubMed DOI PMC

Lancella L., Vecchio A. L., Chiappini E., et al., “How to Manage Children Who Have Come Into Contact With Patients Affected by Tuberculosis,” Journal of Clinical Tuberculosis and Other Mycobacterial Diseases 1 (2015): 1–12, 10.1016/j.jctube.2015.07.002. PubMed DOI PMC

Doležalová K., Mališková B., Honegerová M., Hromádková M., and Wallenfels J., “TB Index Case Tracing in the Roma Community in the Czech Republic,” Epidemiology and Infection 152 (2024): e45, 10.1017/S0950268824000384. PubMed DOI PMC