Pulmonary tuberculosis presenting as ruptured pneumatocele with pnemomediastinum

Pneumatoceles occur as a sequelae to acute pneumonia caused by Staphylococcus aureus. We present a case of 4 month old infant who was a twin with cough, breathlessness for one month and history of not gaining weight for one month. The child had contact history for tuberculosis. Chest radiograph was reported as pneumatocele and CT was reported as 'rupture pneumatocele with pneumo - mediastinum'. Gastric juice aspirate showed 7 AFB in 100 oil immersion fields and thus confirmed the diagnosis of childhood tuberculosis. Anti - tubercular drugs were started in accordance to RNTCP 2013 guidelines under 'new case' category. The child, on follow up was found to be in good compliance with drugs and had gained weight. Chest radiograph was repeated after 4 months of treatment and showed resolution of pneumatocele. HIs parents and twin brother were screened for tuberculosis and were found to be negative. INH prophylxis was started for his twin brother.