Cerebral aspergillosis and pulmonary tuberculosis in a child with chronic granulomatous disease.
BACKGROUND
Chronic granulomatous disease (CGD) is an immune disorder that affects phagocytes. It is characterized by recurrent or persistent bacterial and fungal infections. Reports of tuberculosis (TB) in patients with CGD are rare. In developing countries, where TB is endemic, possibility of other chronic infections is often overlooked by physicians.


METHODS
We report the case of a 4-year-old boy who had recurrent respiratory infections and episodes of headache. He was put on antituberculosis (ATT) drugs without microbiological or pathological evidence 2 months prior to presentation. The child did not improve and was brought to our hospital where a computed tomography scan revealed multiple cerebral abscesses. These abscesses were excised. The microbiological specimen was determined to be positive for Aspergillus fumigatus. His tracheal aspirate was positive for Mycobacterium tuberculosis polymerase chain reaction assay. Further work-up confirmed the diagnosis of CGD in the child.


CONCLUSIONS
This report describes the course of the patient's illness in order to highlight the challenges associated with the management of these infections. We also aim to stress on the importance of pathological diagnosis before starting a therapy.
Department of Surgery, Section of Neurosurgery, The Aga Khan University Hospital Karachi, Pakistan.
Muhammed
M
Waqas
Department of Surgery, Section of Neurosurgery, The Aga Khan University Hospital Karachi, Pakistan.
Sidra
S
Zafar
Department of Surgery, Section of Neurosurgery, The Aga Khan University Hospital Karachi, Pakistan.
Tooba
T
Rehman
Department of Surgery, Section of Neurosurgery, The Aga Khan University Hospital Karachi, Pakistan.
Muhammed
M
Riyaz
Department of Surgery, Section of Neurosurgery, The Aga Khan University Hospital Karachi, Pakistan.
Muhammed E
ME
Bari
Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital Karachi, Pakistan.
Romana
R
Idrees
Cerebral abscess; chronic granulomatous disease; tuberculosis