A unique association of diaphragmatic hernia and pulmonary tuberculosis in an infant

We report a healthy-appearing 7-month-old girl of non-related ancestry, uneventful pre - and postnatal development and past medical history, who was investigated for lung Tuberculosis (TB) in her mother. Tuberculin skin test was highly positive (20 mm induration, normal range 0-5 mm in unvaccinated children). Chest X-ray (CXR) revealed a surprising image suggestive of the presence of abdominal contents in the thoracic cavity (Figure 1); the unobscured lung parenchyma showed no signs of TB. Computed Tomography (CT) imaging detected branching linear opacities and patchy consolidation in the right upper lobe, intrathoracic lymphadenopathy and confirmed retrosternal dislocation of colon (Figure 2 A,B,C). Thus, the diagnosis of concurrent lung TB and Congenital Diaphragmatic Hernia (CDH) was established. The 4-drug regimen of antituberculotics was initiated, i.e. isoniazid, rifampicin, pyrazinamide and ethambutol. The hernia repair was deferred to prevent abdominal dissemination of Mycobacterium tuberculosis