Septic Shock Due to Tuberculosis in Down Syndrome

A 16 year old boy, known case of Down syndrome, was brought with history of fever and cough for 2 weeks, and cold extremities and breathing difficulty for last 12 hours. There was no history of diarrhea, vomiting or blood loss. Child was fully vaccinated for age and had a BCG scar. Capillary refill time was prolonged, heart rate was 160/ min and blood pressure was 80/60 mm Hg (below 5th centile). Except for bilateral crepitations, systemic examination was normal. Child was managed on lines of septicemic shock. Normal saline bolus, antibiotics, vasopressor support, oxygen and packed red cell transfusion were given.