Multifocal Tuberculosis with Pre-Extensive Drug Resistance (Clinical Case)

Abstract

We present our own observation of the multifocal tuberculosis with pre-extensive drug resistance (pre-XDR-TB) development in a patient who was treated in the pulmonary tuberculosis department No. 2 of the Zaporizh­zhia’ regional phthisio-pulmonology clinical treatment and diagnostic center. Multifocal pre-XDR-TB developed in the patient 2.5 months after the initial diagnosis of destructive disseminated pulmonary tuberculosis. The patient was treated during 2 months with deforming arthrosis, which turned out to be tuberculosis of the left knee joint until the specified changes in the lungs were detected, which indicates its late diagnosis. The patient was not tested for HIV infection when tuberculosis was detected in the primary care, and after 2.5 months it was firstly found and accompanied by severe immunosuppression (CD4 lympho­cytes count was 94 cells). This fact also indicates a late diagnosis of HIV infection. As a result of untimely diagnosis and treatment of disseminated pulmonary tuberculosis in the pre-XDR-TB patient with combined HIV infection, there was a rapid generalization of a specific process with the development of multifocal tuberculosis involving not only the bronchopulmonary system, but also the left eye (focal chorioretinitis), the heart (exudative pericarditis), brain (meningoencephalitis) and the left knee joint. The presented clinical case also shows the irresponsibility of the patient to his healthy and the poor work of the family doctor in explaining to the patient the importance of timely tuberculosis treatment. Thus, in the described clinical case, a late-diagnosed HIV infection with severe immunosuppression may have been the trigger for the development of multifocal tuberculosis with extensive drug resistance in the patient and untimely treatment of disseminated pulmonary tuberculosis led to rapid generalization of the specific process. More responsible work of family doctors with tuberculosis patients is also necessary. Therefore, timely diagnosis of multifocal tuberculosis and the earliest appointment of antimycobacterial therapy will allow not only to achieve positive results in treatment, but also to prevent the complications’ development.