Sirolimus Therapy in Generalized Lymphatic Anomaly With Tuberculosis: A Case Report

We report the case of a critically sick previously healthy 14-year-old girl who presented with subacute dry cough, respiratory distress, chest pain, hepatosplenomegaly, lytic bone lesions, splenic involvement, and bilateral chylothorax. Radiological evaluation established a diagnosis of Generalized Lymphatic Anomaly (GLA). The patient showed limited response to propranolol and pleurodesis but improved after initiation of sirolimus and vincristine. Notably, pleural fluid culture yielded Mycobacterium tuberculosis, leading to the addition of antitubercular therapy (ATT). The child subsequently demonstrated sustained clinical improvement with combined sirolimus and ATT. This case highlights the rare coexistence of GLA and tuberculosis, emphasizing the need to consider dual pathology when evaluating persistent pleural effusions in children.