Perinatal tuberculosis presenting as endobronchial tuberculosis diagnosed by bronchoscopy: a case report

A 3-month and 17-day-old male infant presented with a 4-week history of cough and was initially diagnosed with pneumonia. Despite over 20 days of antibiotic therapy (including ceftriaxone, piperacillin-tazobactam, and vancomycin), his condition failed to improve. Chest CT revealed worsening pulmonary infiltrates. Bronchoscopic findings revealed stenosis of the left main bronchus with mucosal erosion, granulomas, and caseous necrosis. Rapid on-site evaluation of bronchoalveolar lavage fluid demonstrated acid-fast bacilli. Together with positive T-SPOT and high-throughput sequencing results for Mycobacterium tuberculosis, a diagnosis of perinatal endobronchial tuberculosis was established. The infant was started on an HRZLzd anti-tuberculosis regimen (isoniazid 10 mg·kg－¹·d－¹ intravenous infusion, rifampicin 12.5 mg·kg－¹·d－¹ orally, pyrazinamide 30 mg·kg－¹·d－¹ orally, and linezolid 10 mg·kg－¹·d－¹ intravenous infusion). After one month of treatment, both his clinical symptoms and pulmonary imaging findings showed marked improvement.