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Coinfezione virale e tubercolosi pleuro-polmonare resistente in età pediatrica: un caso clinico
Viral coinfection and resistant pleuropulmonary tubercolosis in a paediatric patient: a clinical case
Lavinia Fioretti1, Sara Chiurchiù2, Laura Cursi2, Lorenza Romani2, Martina Di Giuseppe2, Stefania Mercadante2, Costanza Tripiciano2, Maia De Luca2, Cristina Russo2, Stefania Bernardi2, Laura Lancella2
1Scuola di Specializzazione in Pediatria, Università “Tor Vergata”, Roma
2UOS Malattie Infettive, IRCCS Ospedale Pediatrico “Bambino Gesù”, Roma
Settembre 2026 | DOI: 10.53126/MEBXXIXST219
Abstract
The paper reports the case of a 14-year-old girl from Moldova presenting with right pleuropneumonia and pleural effusion unresponsive to first-line antibiotic therapy. Despite initial positivity for respiratory viruses (influenza A, parainfluenza 3 and adenovirus in the pleural fluid), persistent symptoms and her origin from a high-burden area raised clinical suspicion for pleuropulmonary tuberculosis. Interferon-gamma release assay, chest CT, molecular testing (PCR) on pleural fluid and biopsy confirmed Mycobacterium tuberculosis infection. Early rapid molecular resistance screening detected a katG gene mutation conferring isoniazid resistance and allowed immediate adjustment of the therapeutic regimen with levofloxacin prior to culture-based susceptibility results. This case highlights how viral co-infections may mask or complicate the paucibacillary presentation of paediatric tuberculosis. Moreover, it emphasises the crucial role of epidemiological history and rapid molecular diagnostics in managing drug-resistant strains.
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