An adult female patient with DS suspected of having active pulmonary TB was unable to produce sputum, which made the diagnosis of pulmonary TB difficult. She was too upset and frightened to cooperate successfully, unable to understand and undergo procedures like sputum induction, gastric lavage or bronchoscopy, thus we applied an unusual procedure like oral cavity brushing to obtain the material and to confirm M. tuberculosis. A hospital-based study has compared sputum obtained by nasopharyngeal aspiration and by sputum induction for staining and culturing of M. tuberculosis [19]. In comparison, oral cavity brushing is less aggressive than the former but proved to be fully effective in our patient. Despite the fact that it was beneficial in the case of DS, we may not recommend oral cavity brushing instead of established routine clinical procedures of sputum examination for the detection of pulmonary TB. However, the method is suitable for patients who are not able to cooperate or to undergo usual diagnostic procedures.

Premature aging is a characteristic of adults with DS. Dementia, or memory loss and impaired judgment similar to that of Alzheimer disease patients, may appear in adults with DS and occurs before the person is 40 years old [3]. Both occurred in our patient.

There was no history of TB in the patient’s medical file. However, besides a mass primary complex, the chest X-ray showed right axillary lymph node indicative of TB sequelae expected from previous extrapulmonary spreading of TB. The BCG vaccination at birth may have proved a protective effect in our patient [21].

Spreading of the TB infection also may occur in sputum-smear negative patients with pulmonary TB, which is an important public health issue [22]. Tuberculosis control depends on successful diagnosis and treatment of active disease [23] and on drug sensitivity testing [24].