Tuberculose associada a nefrocalcinose em um lactente

Objetivos: Relatar um caso clinico de tuberculose de apresentacao nao usual.Descricao do caso: Uma lactente de oito meses, sem infeccao pelo virus de imunodeficiencia humana (HIV), filha de mae seropositiva para HIV e com tuberculose pulmonar, foi internada por febre com 15 dias de evolucao, sem outra sintomatologia. A radiografia de torax revelou multiplos focos de hipotransparencia bilateralmente e a prova de tuberculina 8 mm. A doente nao havia recebido a vacina BCG. Realizou broncofibroscopia que evidenciou compressao extrinseca da arvore traqueobronquica, causada por multiplas adenopatias, confirmadas por ressonância magnetica nuclear do mediastino. Na ecografia abdominal foram encontrados aspectos sugestivos de nefrocalcinose. Os estudos do metabolismo calcio-fosforo e da funcao renal nao revelaram alteracoes. Iniciou terapeutica antibacilar tripla e corticoterapia. Foi isolado Mycobacterium tuberculosis no lavado bronco-alveolar. Verificou-se boa evolucao clinica, tendo alta com 27 dias de terapeutica antibacilar.Conclusoes: Este caso clinico destaca-se pela forma incomum de apresentacao da tuberculose, com a presenca de nefrocalcinose. As perturbacoes do metabolismo do calcio associadas a tuberculose sao raras, mas tem implicacao no seguimento e no prognostico. Aims: To report a case of tuberculosis with unusual presentation.Case description: An eight months old infant without infection by the human immunodeficiency virus (HIV), born of an HIV-positive mother with pulmonary tuberculosis, was hospitalized for fever lasting 15 days, with no other symptoms. Chest radiography revealed multiple bilateral nodular opacities and the tuberculin test was 8 mm. The patient had not received BCG vaccination. Bronchoscopy showed extrinsic compression of the tracheobronchial tree, caused by multiple adenopathies, confirmed by nuclear magnetic resonance imaging of the mediastinum. Abdominal ultrasound was suggestive of nephrocalcinosis. Phospho-calcium metabolism and renal function studies showed no alterations. Triple antituberculous therapy and corticosteroid were started. Mycobacterium tuberculosis was isolated in bronchoalveolar lavage. There was good clinical outcome and the patient was discharged with 27 days of antituberculosis therapy.Conclusions : This case stands out for its unusual presentation , with the presence of nephrocalcinosis. Disturbances of calcium metabolism associated with tuberculosis are rare, but have implications for the follow-up and prognosis.