Page 400 - Abstract Book KONIKA 18

Respirology

P-RES-020
Multiple Giant Bullae in the Right Upper Lobe:
A Rare Case Presentation of Tuberculosis in Children

1
Rifan Fauzie , Dicky Aligheri 2
1
2
Pediatric Respirologist and Thoracis Surgeon , Brawijaya Hospital Saharjo, Jakarta, Indonesia
Abstract
Background There are many clinical manifestations of tuberculosis. Some of them are mimicking other
diseases, especially in non-classical cases. Unfortunately, overlooked cases often lead to poor management
and worsening symptoms. We report a rare case of tuberculosis with multiple giant bullae in the upper
right lobe in a child. Objective To demonstrate a rare case of tuberculosis manifestation in a child with
multiple giant bullae in the right upper lobe. Case A-6-year-old girl came to our hospital with productive
cough, tachypnea and fever for the last 2 weeks. No history of recurrent respiratory infection nor household
contact of tuberculosis patient, but she hard to gain weight. TST was negative. The parents noticed there was
asymmetrical in her chest since the age of 1 year. The right lung sound was decreased. The CXR showed
massive radio-opaque lesion and air-fluid level in the right lung, CT scan showed multiple giant bullae with
empyema. IGRA was negative. She was treated with ceftriaxone for 10 days and then underwent bullectomy.
The lobe was destroyed with multiple giant bullae and caseous necrotization. Histopathology exams revealed
to tuberculosis as presented by chronic granulomatous cells and Datia Langhans cells. She is now treated
with antituberculosis drugs and still in a close monitoring. Conclusion Tuberculosis manifestation in children
is vary. Evaluation of a child with respiratory symptoms and asymmetrical chest should include modalities
such as chest x-ray or CT scan to determine the probability of any pathology found.
Keywords: tuberculosis; bullae; asymmetric; histopathology; antituberculosis

P-RES-021
Scrofuloderma and Tuberculosis Spondylitis in Children

Risnawati, Emilda
Ciawi Regency Hospital, Bogor Regency, Bogor, West Java, Indonesia

Abstract
Background Scrofuloderma is a manifestation of TB in the skin that occurred due to the dissolving of the
percontinuitatum of the lymph nodes affected by TB, while tuberculosis spondylitis is an infection of the
mycobacterium tuberculosis germ that hits the spine, known as Pott's disease. Objective To report a patient
with tuberculosis spondylitis in outpatients. Case A 15-year-old girl was consulted with a diagnosis of a
spinal tumor infected with tuberculosis spondylitis. Anamnesis shows a festering lump on the lower back
with wound more than 8 months. Fever was confirmed but without any history of coughing nor contact with
tuberculosis patients. Post examination shows malnutrition and multi nodules in the Colli area were found, as
well as 3-4 cm abscesses diameter on the lumbar III-high back area. The supporting examination indicated an
increase in LEDs (47) and thoracic x-rays resulted a picture of pulmonary TB dd pneumonia, with a positive
Mantoux test result. There is a narrowing of the intervertebral foramen on lumbar photo examination and
gives an overview of sacred lumbarization, confirming Scrofuloderma with tuberculosis spondylitis which
was subsequently treated with RHZE. Wound was cleaned and sampled for histopathological examination.
Results showed granulomatous inflammation of the lumbar vertebrae that might occur due to tuberculosis.
Patient is under treatment with a good therapeutic response. Conclusion Scrofuloderma and Tuberculosis
spondylitis was confirmed based on anamnesis results and clinical findings. The patient’s treatments were
operative action and the administration of tuberculosis medicines.
Keywords: scrofuloderma; spondylitis tuberculosis; tuberculosis; Pott's disease

352 KONIKA XVIII Abstract Book