Children with B-cell acute lymphoblastic leukemia (B-ALL) present with a compromised immune system, making them more susceptible to various infections. Mycobacterial infections are not frequently recognized in children with ALL or cancer, and the literature detailing tuberculosis (TB) in pediatric oncology from high-incidence regions is limited. We describe three cases of B-ALL and one case of Non-Hodgkin Lymphoma (NHL) that presented with refractory pneumonias ultimately presumed to be TB, as well as one with seizures. Because immunocompromised children commonly exhibit paucibacillary TB, early diagnosis becomes a significant challenge. Paradoxically, the benefits of empirical treatment in this subgroup are substantially greater than the risks, including hepatotoxicity. Given that TB is a severe infection in immunocompromised children, empirical treatment may be initiated when there is strong clinical suspicion after a thorough evaluation of the risks associated with concurrent chemotherapy, especially in children from endemic regions.
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