Objective
TB in pediatric often-missed or overlooked due to non-specific symptoms and difficulties in diagnosis. Adolescent comprises one-third pediatric tuberculosis population. Undernutrition increases the risk of TB, which in turn can lead to malnutrition. This case report describe milliary tuberculosis with marasmic-type malnutrition in 13-year-old girl.
Case
A 13-year-old girl came to emergency room with dyspnea. The complaint began with productive cough, fever, night sweat, malaise and weight loss since 6 months before admission. The contact with BTA positive patient was unclear. The Physical examination showed the respiration rate and heart rate were above normal range. The multiple lymphadenopathy were also found during palpation. Thorax examination revealed bilateral crackles with chest retraction. The chest x-ray was done and it represented miliary-spread tuberculosis. The rapid molecular test detected a low number of Mycobacterium tuberculosis. The TB score of the patient was 6, which establish the diagnosis. The complete blood count examination showed microcitic-hypochromic anemia with elevated neutrophil count. Anthropometric examination result were severe underweight and stunted. Baggy pants and muscle wasting was also found4. This patient were admitted to isolation ward and treated with anti-tuberculosis regimen, cefotaxime, prednisone, and paracetamol. We also did interprofesionnal collaboration with dietitian to solve nutritional related problem in this patient.
 Conclusion
The clinical presentation of TB in adolescent have feature seen in both younger children and adults. TB and undernutrition can cause a vicious cycle of worsening disease. The role of nutrition is important for both prevent TB infection and improve its prognosis.