WOFAPS 2025 8th World Congress of Pediatric Surgery

Andrea Santino Tenorio, Ricardo Escartin Villacampa, Paulina Vargova, Alvaro Mayordomo Ruiz, Paolo Bragagnini Rodriguez

Hospital Universitario Miguel Servet

Introduction:
Tuberculosis (TB) remains a major global health concern, particularly in pediatric populations from endemic regions. While pulmonary involvement is common, extrapulmonary manifestations such as uveitis are rare and can lead to significant morbidity. Persistent inflammatory responses despite adequate antituberculous therapy (ATT) present a therapeutic challenge. We report a case of pediatric tuberculous uveitis associated with a mediastinal mass, successfully managed with surgical resection after failure of medical treatment.

Case Report:
A 12-year-old girl, recently immigrated to Spain from Colombia, presented with bilateral intermediate uveitis, vitritis, and subcapsular cataracts. Initial treatment with corticosteroids led to partial improvement. Imaging revealed a right hilar mediastinal mass (8x5.6 cm) compressing the bronchus, left atrium, and major vessels. Diagnosis of tuberculous mediastinitis was confirmed by PCR detection of Mycobacterium tuberculosis in samples from the mass and ocular fluids. Standard ATT was initiated, combined with immunosuppressive therapy. Despite finishing the treatment, ocular inflammation persisted, impairing visual acuity.

A multidisciplinary team concluded that the mediastinal mass acted as a persistent inflammatory focus. The patient underwent right thoracotomy with complete resection of the mass, histologically confirmed as necrotizing granulomatous lymphadenitis consistent with tuberculosis. Postoperatively, uveitis resolved rapidly, with full recovery of visual acuity (1.0 bilaterally) and no recurrence at 6-month follow-up, allowing tapering of immunosuppressive therapy.

Conclusion:
This case highlights the critical role of surgical intervention in managing complex extrapulmonary tuberculosis with immune-mediated complications. In refractory cases where residual tuberculous lesions perpetuate inflammation, surgical resection should be considered as part of a multidisciplinary approach. Early identification and timely surgery can significantly improve outcomes in pediatric TB patients with severe extrapulmonary manifestations.