12 years female child visited me with the complaint of single episode of hemoptysis.

There was no history of fever,no history of cough other than the present single episode of cough.

There was no history of loss of appetite or weight loss in last 3 months

There was no contact with Tuberculosis patient in past 2 years

On examination -The anthropometry was appropriate for the age,General physical examination was normal

On systemic examination- Chest on auscultation revealed deep inspiratory  crackles over right mammary region

On investigation-Chest X-ray showed consolidation in the right mid zone

Montoux test was non reactive,CBC was non contributory

There was no cough after that single episode so sputum could not be collected and nothing came after induced sputum.

The child did not allow gastric aspiration even after counselling.

Coagulation profile was normal

At this time I planned bronchoscopy to look for the region of hemoptysis.

On bronchoscopy,there was a clot in right bronchus intermedius and collected BAL fluid

BAL fluid was sent for CBNAAT and it came positive for Mycobacterium tubrculosis which was sensitive to Rifampicin

ATT was started from DOTS centre and the child id doing well.

This is the unusual presentation of tuberculosis in children with a single episode of cough with hemoptysis and no other symptoms.