Intestinal tuberculosis with multiple intestinal perforations in a 5-month-old infant: The role of metagenomic next-generation sequencing: a case report and literature review.
Bei Wang, Yipaguli Simijiang, Gulibiya Kaheman et al.
✦ AI-curated · Sources linked
Case in brief
A 5-month-old boy presented with fever and abdominal distension that progressed to intestinal obstruction and multiple perforations involving the distal ileum and appendiceal region. Conventional tuberculosis tests, including the tuberculin skin test and interferon-gamma release assay, were negative. Surgical exploration and metagenomic next-generation sequencing (mNGS) of peritoneal drainage fluid identified Mycobacterium tuberculosis complex; mesenteric nodules were positive for acid-fast bacilli on Ziehl-Neelsen staining. After surgery and multidrug anti-tuberculosis treatment, he improved clinically and gained weight. The ileostomy remained in place, with closure planned after nutritional recovery.
What made this case unusual
The case involved multiple intestinal perforations in a 5-month-old infant without a known history of tuberculosis exposure, despite negative conventional TB investigations; mNGS helped establish the diagnosis.
Diagnostic / clinical pearl
Negative tuberculin skin and interferon-gamma release tests did not exclude intestinal tuberculosis in this infant. In severe unexplained intra-abdominal infection, mNGS of peritoneal fluid may aid diagnosis when conventional investigations are inconclusive.