Both Immune dysfunction and deficiency, are known in Down syndrome. Tuberculosis commonly presents as insidious illness and septicemic shock is its rare presentation, mostly in immunocompromized patients. We report a 16 year old boy with Down syndrome presenting with septicemic shock due to tuberculosis.

Key words: Immune deficiency, Trisomy 21, Tuberculosis.

Hemogram revealed hemoglobin 8 g/dl, total leucocytes count (TLC) 8600 cells/cubic mm, platelet count-2,10,000/cubic mm. X-ray chest suggested patchy opacities with multiple cavitatory lesions in both lungs. Sonography of abdomen was normal. Echocardiogram revealed normal structural and functional cardiac condition. Blood culture was sterile. Widal test was negative. Sputum microscopy examination revealed acid fast bacilli (AFB) (Mycobacterium tuberculosis). Child was started on 4 drug antitubercular treatment (ATT). Hemodynamic improvement started on day 3 and vasopressor treatment was gradually withdrawn by day 6 of admission. Oxygen support was gradually withdrawn and weaned off on day 7 of admission. Category I Direct Observed Treatment Short course (DOTS) [4] was started and patient was discharged after 10 days of admission. Patient is on regular follow up and has clinically improved considerably. Follow up chest X-ray after 5 months revealed fibrocystic changes in the lungs suggestive of healing tuberculosis. Repeat sputum examinations (as per DOTS protocol) were negative for AFB.

There is an increased incidence of respiratory infections in children with Down syndrome. Although every arm of immune system shows evidence of dysfunction in these patients, particularly T cells (CD4+ and suppressor T cells) and NK cells show marked derangement of number and activity [5-9]. No data has so far shown difference in incidence of tuberculosis in this syndrome and general population [10].

Septicemic shock is commonly caused by pyogenic organisms. It is reported to be caused by tuberculosis in immunocompromized patients only [1-3]. We thus suspected some immunodeficiency or dysfunction in our case. This case was HIV negative and had normal total leukocyte count.

In the absence of adequate facilities, we were not able to exactly point out the immune defect in our patient. The possibility of immune dysfunction in Down’s syndrome as a cause of shock in mycobacterial infection can be explored further, in view of similar presentation seen in cases of acquired immunodeficiency [2,3].

Contributors: BM, SN and VKG were involved in clinical management of the case, literature search and writing the paper. All authors approved the final manuscript.

Funding: None;

Competing interests: None stated.

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