The unusual face of pediatric tuberculosis: Osteo-pleuro-pulmonary dissemination a case report

Abstract

Tuberculosis (TB) remains a major cause of morbidity and mortality in children, particularly in endemic regions. While pulmonary TB is the most common form, disseminated TB represents a severe and uncommon manifestation, marked by hematogenous spread of Mycobacterium tuberculosis to multiple organs, often resulting in a complex clinical picture and significant diagnostic challenges—especially in young children. This case is notable due to the patient's young age and the unusual distribution of lesions, both of which increase the risk of fatal outcomes if diagnosis is delayed. We present the case of a 4-year-old boy with confirmed disseminated TB involving the mandible, vertebrae, ribs, pleura, and lung parenchyma. The clinical course began with a mandibular lesion initially interpreted as osteomyelitis secondary to cellulitis from an insect bite, treated with antibiotics and surgical drainage without improvement. Due to clinical findings, symptoms persistence, histopathologic and imaging findings raised suspicion of TB, later confirmed by molecular testing. The patient started first-line anti-tuberculous therapy and showed favorable clinical evolution. This case highlights the importance of including disseminated TB in the differential diagnosis of atypical chronic osteolytic lesions in the pediatric population.