Rasmussen’s Aneurysm in a Child with Multidrug Resistant Pulmonary Tuberculosis

Excerpt

To the Editor: We present a 7-and-a-half-year-old boy who was referred to us in May 2018 for management of his multidrug-resistant (MDR) pulmonary tuberculosis (PTB) with left sided pleural effusion. Sputum microscopy and GeneXpert were positive for acid fast bacilli (AFB) (2+) and rifampicin resistant Mycobacterium tuberculosis (MTB) respectively. He was started on kanamycin (Km), high dose moxifloxacin (Mfx), para-aminosalicylic acid (PAS), cycloserine (Cs) and clofazimine (Cfz) as second-line anti-tubercular treatment (ATT) regime. In June 2018, he had hemoptysis for 4 d. His hemoglobin dropped from 8.4 g/dl to 6.1 g/dl. He was immediately hospitalised, transfused with packed red blood cell (PRBC) transfusion and underwent an urgent contrast enhanced CT chest (CECT) with pulmonary angiography, which revealed destruction of entire left lung parenchyma with bronchiectasis, areas of necrotic breakdown in the left lower lobe with a large 1.9 × 2.0 cm sized Rasmussen’s aneurysm. On the same day, he expectorated 120 ml of frank blood for which he received PRBC transfusion again. He underwent trans-catheter intra-aneurysmal glue embolization of the Rasmussen’s aneurysm under general anesthesia. He had no further episodes of hemoptysis. He was observed for one week and then discharged. …