Aspergillosis and pulmonary tuberculosis co-infection in a 9-year-old with B-cell acute lymphoblastic leukemia

This case report highlights the infrequent occurrence of coinfection involving invasive aspergillosis and Mycobacterium tuberculosis (MTB) in pediatric patients. We present the case of a 9-year-old Thai girl diagnosed with B-cell acute lymphoblastic leukemia, who experienced prolonged febrile neutropenia lasting 1 month during chemotherapy. Chest computed tomography (CT) revealed lung nodules with an air crescent sign, while CT angiography of the brain detected an infected ruptured brain aneurysm, which exhibited septate hyphae with acute angle branching, consistent with invasive aspergillosis. Despite voriconazole treatment, the patient’s high-grade fever and dyspnea persisted. Further investigations revealed a lung abscess and wedge resection confirmed AFB 1+ and positive MTB detection via polymerase chain reaction, leading to the initiation of combined treatment for pulmonary tuberculosis and invasive aspergillosis. Considering drug–drug interactions was an essential aspect of the management. This case report highlights challenges of coinfection between invasive aspergillosis and MTB.