Conclusion
A rare case of MDR-TB cervical lymphadenitis in a 2-month male infant was reported from the mother with pulmonary TB. According to results ofMtb strains genotyping, it was determined that his mother was infected by the multiple Mtb strains and possibly the infant boy was infected with regards to the congenital-TB route rather than the environment. Congenital TB symptoms were various in the infants and it could be converted to TB-disseminated infection. There was no evidence of disseminated infection for the present case using radiological findings, laboratory indexes and bacterial culture testing. Surprisingly, we confronted with an MDR-TB infant case delivered from a drug-susceptible pulmonary-TB mother case, which is quite uncommon. The physician decision was initiated with the first-line anti-tuberculosis therapy without the DST (Drill Stem Test) result due to time-consuming aspect of the Mtb culture and this peculiar emergency case. However, we performed DST by the molecular techniques and identified that the infant was an MDR-TB case. There are several points to be considered in this case, which including (i) Iran is TB endemic region and it is necessary to introduce new local TB control programs such as performing DST and anti-tuberculosis regimen should be recommended based on the DST pattern in such a region; (ii) Clinical manifestations of cervical tuberculosis lymphadenitis were not very unique and could be confused with other infections, particularly in the absence of the response to Category I anti-TB regimen treatment due to the DR-TB infection, as in the present case; (iii) The fine needle aspiration (FNA) technique with the molecular methods can diagnose the cervical tuberculosis lymphadenitis cases with great accuracy; (iv) Although the DR-TB strains should be diagnosed quickly, the cervical tuberculosis lymphadenitis infections caused by these strains are not usually fatal, in case they are properly administered and given antibiotic-based drug susceptibility testing; (v) Fluoroquinolone is an appropriate therapeutic agent for the prophylactic aspect of contacts with the MDR-TB cases.