Bronchiolitis Obliterans in an Infant with Multi Drug Resistant Pulmonary Tuberculosis - Do Not Forget Respiratory Syncytial Virus Co-Infection - Abstract
A 14-month-old boy with multi-drug resistant (MDR) pulmonary tuberculosis (PTB) on moxifloxacin, paraaminosalicylate (PAS), clofazimine, linezolid and cycloserine since 5 months of age had fever and cough for 3 days, increased respiratory activity for 2 days and generalized erythematous rash over body for a day. CT chest showed areas of air trapping in bilateral upper and lower lobe lung parenchyma suggestive of bronchiolitis obliterans. Nasopharyngeal aspirate multiplex PCR for respiratory panel was positive for respiratory syncytial virus (RSV). He was treated with oral ribavirin, steroids and high flow nasal cannula (HFNC). This case highlights the rarity of such co-infections and highlights that not all worsening of PTB is treatment failure and one should always keep in mind co-infections with other respiratory pathogens.