Diagnostic Pitfall Thoraco-abdominal Neuroblastoma Initially Misdiagnosed as Pulmonary Tuberculosis

Abstract

Neuroblastoma is the most common extracranial solid malignancy of childhood and typically arises from neural crest cells of the sympathetic nervous system, most frequently in the adrenal medulla or paravertebral sympathetic chain. Thoracic or thoracoabdominal localization is less common and may present with nonspecific respiratory symptoms that mimic infectious diseases. We report the case of a three-year-old boy presenting with prolonged fever, persistent cough, and progressive weight loss. Initial chest radiography and pleural fluid analysis suggested pulmonary tuberculosis, and antituberculous therapy was initiated.However, the absence of clinical improvement prompted further evaluation. Contrast-enhanced thoracoabdominal computed tomography revealed a large prevertebral mass extending into the posterior mediastinum. Ultrasound-guided biopsy followed by histopathological and immunohistochemical examination confirmed the diagnosis of neuroblastoma. Staging investigations demonstrated bone and bone marrow involvement consistent with high-risk disease. The patient was treated according to the NBL-MA- 2010 protocol with significant clinical improvement and is currently scheduled for consolidation with autologous stem cell transplantation. This case highlights an important diagnostic pitfall in tuberculosis- endemic regions and emphasizes the importance of early cross-sectional imaging and tissue diagnosis in children presenting with persistent thoracic pathology.Categories: Oncology, Pediatrics