# Misleading presentation of tuberculosis in a child with CGD revealing invasive aspergillosis: A molecularly confirmed case

## TL;DR

A child with chronic granulomatous disease was initially diagnosed with tuberculosis but later found to have invasive aspergillosis, confirmed by molecular testing and successfully treated with antifungal drugs.

## Contribution

This case highlights the diagnostic challenge of distinguishing TB from invasive aspergillosis in CGD patients and confirms the effectiveness of specific antifungal therapies.

## Key findings

- A 4-year-old CGD patient initially diagnosed with TB was found to have invasive aspergillosis.
- Molecular testing confirmed the fungal isolate as Aspergillus fumigatus.
- Treatment with liposomal amphotericin B and caspofungin led to successful recovery.

## Abstract

Patients with chronic granulomatous disease (CGD) are susceptible to serious infections including, invasive aspergillosis (IA), which remains a major cause of morbidity and mortality. The diagnosis and management are often challenging due to overlapping clinical features and variable treatment responses.

Here we report a 4-year-old girl with CGD who admitted with cellulitis, a chest wall abscess, and fever. She had a history of recurrent pneumonia since infancy and a prior diagnosis of tuberculosis (TB). Despite broad-spectrum antibacterial, her condition did not improve. Direct microscopic and macroscopic investigations revealed fungal infection with Aspergillus species.

Molecular identification confirmed the isolates as A. fumigatus. According to the antifungal susceptibility testing, amphotericin B and posaconazole demonstrated strongest activity and the patient was successfully treated by liposomal amphotericin B (50 mg/day) and caspofungin (35 mg/day).