Antituberculosis Drug Therapy Research Articles

Identification of Urinary Glucose and Urinary Ketones in Pulmonary Tuberculosis Patients Receiving Anti-Tuberculosis Drug Therapy (OAT) at the Tlogosari Wetan Health Center

Tuberculosis is a contagious infection caused by Mycobacterium tuberculosis. Anti-Tuberculosis Drug Therapy (OAT) given also has side effects, one of which is hepatotoxicity. Laboratory examination of urine glucose identification can show if there is damage to the kidney glomerulus in the filtration process. OAT such as isoniazid can affect the breakdown of fat and cause increased ketone production, especially in individuals who have low carbohydrate intake so that if the excess amount will be excreted through urine (ketonuria). The purpose of this study was to identify urine glucose and urinary ketones in non-DM pulmonary TB patients with OAT treatment at the Tlogosari Wetan Health Center based on treatment phase, gender, and age. This type of research is descriptive observational with a cross sectional approach. The study sample was a urine sample from a non-DM pulmonary TB patient. The examination method used is dyeing using a reagent strip test. The results of the study from a total of 30 non-DM pulmonary TB patients with OAT therapy (100%). A total of 6 (20%) patients identified urinary glucose, with details of intensive phase treatment 2 (7%) trace urine glucose patients (±), while in advanced phase 2 (7%) patients identified trace urine glucose (±) and 2 (7%) low urine glucose patients (+1). The majority of positive urine glucose results were experienced by men with vulnerable elderly age (46-65 years) as many as 4 patients (14%). The results of urine ketone identification showed that 2 (6.6%) patients were identified with urine ketones, namely trace (±) in the intensive phase treatment, while 15 patients in the advanced phase of urine ketones were all negative.The majority of positive urinary ketone results were experienced by vulnerable men of adult age (26-45 years) as much as 2 caseins (14%). Conclusion: Of the 30 non-DM pulmonary TB patients with OAT therapy who met the inclusion criteria, there were 6 (20%) patients identified with urinary glucose and 2 (6.6%) patients identified with urinary ketones. The impact of this study is expected to encourage non-DM pulmonary TB patients to take OAT and do regular medical check-ups.

A Case of Primary Tuberculosis of the Paranasal Sinuses

Tuberculosis of the paranasal sinus is a rare disease caused by infection with Mycobacterium tuberculosis, the causative agent of pulmonary tuberculosis. Although the worldwide incidence of tuberculosis is declining, the diagnosis of primary paranasal tuberculosis remains challenging and cannot be ruled out in patients presenting with refractory chronic rhinosinusitis after adequate surgical and medical treatment. We experienced a case of paranasal tuberculosis with no evidence of previous tuberculosis infection. It was diagnosed after a surgical biopsy revealed granulomatous inflammation and caseous necrosis. The patient responded well to antituberculosis drug therapy and became free of symptoms after 7 months of treatment. We report our findings in this case with a review of the recent literature.

Differences in Vitamin D3 Levels in Pulmonary Tuberculosis Patients Before and After One Month of Anti-Tuberculosis Drug Therapy

Pulmonary tuberculosis is an infectious disease caused by infection with the bacteria Mycobacterium tuberculosis. Patients diagnosed with pulmonary tuberculosis will receive Anti-Tuberculosis Drug (OAT) therapy for six months. In the first two months or what is called the intensive phase, the patient will be given a combination of OAT in the form of rifampicin, isoniazid, ethambutol and pyrazinamide. Several types of anti-tuberculosis drugs have the potential to affect vitamin D3 metabolism, either by interfering with absorption, metabolism or changing the action of vitamin D3. The long-term treatment process for pulmonary tuberculosis also results in a decrease in vitamin D3 levels in the blood. This study aims to determine the difference in vitamin D3 levels in pulmonary tuberculosis sufferers before and after one month of anti-tuberculosis drug therapy. This type of research is descriptive observational with a prospective cohort design without comparison. The total sample was 16 newly diagnosed pulmonary tuberculosis sufferers at the Bangetayu, Kedungmundu and Tlogosari Wetan Health Centers, Semarang City. Vitamin D3 levels in serum samples were examined using the ELISA method. The mean vitamin D3 level before OAT therapy was 19.00 ± 10.45 ng/mL, the level decreased after OAT therapy, namely 18.51 ± 4.74 ng/mL. These results indicate that administration of anti-tuberculosis drugs may have an effect on vitamin levels.

The Effect of Initial Anti-tuberculosis Drug Therapy on Transminase Enzymes

Tuberculosis is still a health problem in the world. TB treatment is carried out in 2 phases, namely early and advanced. This study aims to determine changes in serum transaminase enzyme levels (SGOT and SGPT) in pulmonary TB patients before and after initial drug administration. This study was observational with a cohort study design study. Observations were conducted in tuberculosis patients who received initial ATD therapy for 2 months for SGOT and SGPT enzyme levels before and after treatment. The subject of the study was a new case of a pulmonary TB patient aged ?16 years. Subjects received initial therapy in the form of isoniazid, rifampicin, pyrazinamide, and ethambutol. Recruitment of subjects through successive sampling methods with informed consent. Using a spectrophotometer, SGOT and SGPT enzyme tests were performed on the median blood serum cubital vein. Data analysis using the Wilcoxon Test. The study involved 19 subjects (10 men and 9 women) aged 16-65 years. Before ATD, the mean SGOT was 22.84 IU/L, and SGPT was 21.37 IU/L. After ATD, SGOT increased to 58.63 IU/L (p = 0.023), and SGPT to 80.84 IU/L (p = 0.007). Of the 19 subjects, 8 experienced a significant increase in SGOT and 5 SGPT. Five cases showed an increase in SGPT in line with SGOT, and 3 cases showed an increase in SGOT without SGPT. One case saw an increase in SGOT and SGPT of more than 5 times the reference value. This study confirms an increase in transaminase enzymes during initial therapy with first-line ATD.

Vitamin D as Supplementary Treatment for Newly Diagnosed Pulmonary Tuberculosis patients

Objective: To compare vitamin D with placebo in patients with pulmonary tuberculosis in terms of clinical improvement and sputum conversion. Materials And Methods: This is a prospective randomized, double blind, placebo controlled comparative study conducted for a period of 12 weeks in a tertiary care centre in south India. Total Subjects were 60 new cases of pulmonary tuberculosis who are getting TB treatment initiation, Subjects were randomly allocated into two groups, group A and group B comprising of 30 patients in each group. Group A received vitamin D and group B received placebo. Dosage of vitamin D was 0.25mg/day, given in initial six weeks of antituberculosis drug therapy. Serum level of 25-hydroxyvitamin D was measured at time of diagnosis and at 8 weeks of anti-tuberculous therapy. Measurements of haemoglobin, leukocyte count and serum calcium were done at beginning and repeated at 6th, 8th and 12 weeks. Acid fast bacilli were examined at beginning and on 6th, 8thand 12 weeks. Primary outcome was evaluation of conversion time of sputum smear; secondary outcome was clinical improvement as assessed by TB score. Results: There is no significant difference in mean values of age, haemoglobin level, calcium level,serum Vitamin D, TB score and total lymphocyte count in both groups at start of study.There was no statistical difference in serum calcium level, haemoglobin level and total lymphocyte level at end of study. Mean serum vitamin D level at 8th week of treatment was 27.83±7.09ng/dl in group A and 18.83±2.27 in group B, there was statistically significant difference between two groups. Sixth week sputum conversion in 30 subjects of vitamin D group is 100% and in placebo group, it is 76.7%, which was statistically significant. Conclusion: Supplementary vitamin D when added to first line anti-tuberculous drugs results in shorter conversion time and less severe TB clinical manifestation without any manifestations of hypercalcemia. Therefore, it is recommended to add vitamin D as supplementary treatment to first-line anti-tuberculous drugs in treatment course of active pulmonary TB.

Reconstruction of complicated spinal tuberculosis with long-segment fibula transplantation: a case report

BackgroundTreating complex cases of spinal tuberculosis (STB) that involve multiple vertebral bodies and cause destruction of the spinal structure, kyphotic deformity, and acute nerve injury can be challenging. This report describes the course of treatment and 5-year follow-up of a complex case of multisegmental STB.Case presentationThis report describes a case of tuberculosis affecting the vertebrae extending from thoracic 12 to lumbar 5 in a 60-year-old woman who suffered sudden paralysis in both lower extremities. The patient underwent emergency posterior paraspinal abscess clearance, laminectomy with spinal decompression. Partial correction of the kyphotic deformity via long-segment fixation from the T9 vertebral body to the ilium in a one-stage posterior procedure. The patient’s neurological status was diagnosed as grade E on the American Spinal Injury Association (ASIA) scale after the one-stage operation. Following standardized 4-combination anti-tuberculosis drug therapy for three months in postoperative patients, the patient underwent two-stage transabdominal anterior abscess removal, partial debridement of the lesion and bilateral fibula graft support. One year after the two-stage operation, the patient’s visual analog scale (VAS) score of back pain was 1 point, and the patient’s erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels returned to normal. Five years after the second-stage operation, the Oswestry disability index (ODI) of patient quality of life was 14 points. There was a 4-degree change in the Cobb angle over five years. During the five-year follow-up period, the grafted fibula did not experience any subsidence.ConclusionFor patients with spinal tuberculosis and acute paralysis, it is essential to relieve spinal cord compression as soon as possible to recover spinal cord function. For lesions that cannot be debrided entirely, although limited debridement combined with anti-tuberculosis drug therapy has the risk of sinus formation and tuberculosis recurrence, it is much safer than the risk of thorough debridement surgery. In this case, an unconventional long-segment fibula graft, pelvis-vertebral support, was an effective reconstruction method.

The effect of isolated probiotics from Indonesian Passiflora edulis sims. on interferon gamma levels in peripheral blood mononuclear cell of adult tuberculosis patients in vitro.

Mycobacterium tuberculosis (M.tb) is unique because the bacteria live intracellularly and hide in macrophages so that they can escape from phagocytosis. This is one of the factors that complicate the treatment of M.tb infections. Interferongamma (IFN-γ) is a compound that plays an important role in macrophage activation to control intracellular pathogens. The purpose of this research is to analyze the concentration of IFN-γ in peripheral blood mononuclear cells of adult Tuberculosis patients (TB) after in vitro administration of multistrain probiotics from indigeneous Indonesian red passion fruit (Passiflora edulis Sims.). The probiotics isolated from red passion fruit were introduced into Peripheral Blood Mononuclear Cell (PBMC) adult TB patients who were undergoing Anti-tuberculosis Drug Therapy (ATD) category one at the Trosobo Primary Health Center (Sidoarjo, East Java, Indonesia), and the patients who were undergoing ATD category one treatment were willing to be involved in this study.Result: The probiotics isolated from fermentation-broth of Indonesian red passion fruit were able to increase IFN-γ levels in PBMC of adult TB patients. The red passion fruit probiotics isolated can increase IFN-γ of adult TB patients increased from 0.82% to 23.17% after in vitro administration.

Disseminated Tuberculosis in Breastfeeding Mother: A Case Report

Background: Disseminated tuberculosis is defined as the involvement of two or more extrapulmonary organs due to Mycobacterium tuberculosis infection, which spreads hematogenously. Disseminated tuberculosis is a life-threatening condition, especially if diagnosis and treatment are delayed. This study aimed to describe disseminated tuberculosis in a breastfeeding mother.
 Case presentation: A 21-year-old woman was admitted to Dr. M. Djamil General Hospital with chief complaints of shortness of breath. The symptoms were accompanied by chronic cough, fever, night sweats, and weight loss. From the physical examination, there was a decrease in left lung breath sounds as high as right intercostal V. On the gene expert results, the PCR was positive for Mycobacterium tuberculosis. Chest X-ray shows a miliary pattern and left pleural effusion. Pleural fluid analysis reveals the presence of exudate. Patients were treated with anti-tuberculosis drugs, namely Isoniazid, rifampicin, pyrazinamide, and ethambutol, with pyridoxine. Anti-tuberculosis drug therapy in the intensive phase is given for 2 months and is continued for 6-9 months for the continuation phase, depending on the patient's clinical condition. Breastfeeding was still continued in this case. The patient's baby is advised to be evaluated for active tuberculosis. 
 Conclusion: There are no contraindications for giving anti-TB drugs to breastfeeding mothers unless the mother has mammary TB or drug-resistant TB. In children under 5 years who have close contact with active tuberculosis patients and, after being evaluated, do not have active tuberculosis, the child is treated as suspected latent TB infection with Isoniazid for at least 6 months and accompanied by pyridoxine administration.

THE RELATIONSHIP BETWEEN THE INTAKE OF ENERGY, PROTEIN, IRON, AND VITAMIN C WITH HEMOGLOBIN STATUS IN PULMONARY TUBERCULOSIS OUTPATIENTS

Background: Pulmonary Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis with a treatment period of 6 months to more than one year. The prevalence of pulmonary TB in Indonesia in 2013 was 40% and in South Sumatra in 2018 was 40%. The management of pulmonary TB patients involves several things, namely adequate rest, anti-tuberculosis drug (ATD) therapy, and adequate food intake (sufficient) to recover the patients' pulmonary TB. Purpose in this study investigated the relationship between energy and protein intake, iron, and vitamin C with Hemoglobin (Hb) status in pulmonary TB patients. Method: The type of research used is an observational analytic study with a cross sectional research design with a sample size of 50 human subjects. Participants were selected according to the inclusion criteria and interviewed using a prepared questionnaire. Participants' food intake was obtained using a 24-hour food recall method for 3 days. Body weight, height, and blood pressure were measured. Blood samples were taken to determine the participants' hemoglobin levels Result: There was no relationship between the Hb value and energy intake (p = 0.658) and protein (p = 0.357), while there was a relationship between the Hb value and iron intake (p = 0.012) and vitamin C (p = 0.001). Conclusion: The results of statistical tests showed a relationship between the Hb value with iron and vitamin C intake, while the energy and protein intake had no relationship with the Hb level in pulmonary TB patients.

Spontaneous pneumothorax in a child with miliary tuberculosis: a case report

Spontaneous pneumothorax is a rare but fatal complication of miliary tuberculosis. We report a 13-year-old boy presenting with shortness of breath. He was diagnosed with miliary tuberculosis with spontaneous pneumothorax, which showed significant improvement after the insertion of a thoracostomy tube and anti-tuberculosis drug therapy.

Validity of automated audiometry for hearing examination in patients with multidrug-resistant tuberculosis.

Background: The objective of this study was to test the validity of automated audiometry as a method of hearing examination in patients with multidrug-resistant tuberculosis. Method s: This was a cross-sectional comparative study with a retrospective approach, using patient medical records. Patients with multidrug-resistant tuberculosis (MDR-TB) were recruited based-on medical records that met the inclusion and exclusion criteria at the Pulmonology outpatient unit, then referred to the Otorhinolaryngology outpatient unit of the Dr. Soetomo Academic Medical Center. The subjects' hearing function was measured with two different devices (automated audiometer and conventional audiometer) before being given anti-tuberculosis drug therapy (aminoglycoside injection) as ototoxicity monitoring from July to December 2019 period. Sensitivity and specificity analysis was used to assess the validity of the test. Results: A total of 36 patients (72 ears) were included. The comparison test results using the Mann-Whitney test showed that there were significant differences between automated audiometry and conventional audiometry in both ears. Analysis values were: sensitivity 80-97%, specificity 37-96%, positive predictive value 74-98%, and negative predictive value 59-96%. Conclusion s: Automated audiometry is valid for use as a method of hearing examination and monitoring in patients with multidrug-resistant tuberculosis.

Clinical diagnosis and treatment of primary thyroid tuberculosis: a retrospective study.

ABSTRACTBACKGROUND:Primary thyroid tuberculosis (PTT) is an uncommon type of extrapulmonary tuberculosis, which is caused by Mycobacterium tuberculosis. It does not have specific clinical manifestations, and most cases are diagnosed through postoperative histopathological examination.OBJECTIVE:To evaluate the diagnostic pattern and management strategy among patients with primary thyroid tuberculosis.DESIGN AND SETTING:Retrospective study on patients with primary thyroid tuberculosis in the First Hospital of Jilin University (Changchun, China).METHODS:Between March 2015 and June 2020, nine cases of PTT were diagnosed and treated in the Department of Thyroid Surgery of the First Hospital of Jilin University. Age at diagnosis, primary symptoms, preoperative biopsy, operation method, pathological classification, acid-fast staining test, anti-TB therapy and prognosis were registered in order to explore the appropriate protocol for diagnosis and treatment of this disease.RESULTS:None of the patients was diagnosed with thyroid tuberculosis before surgery. All the patients underwent surgery. Granulomatous changes or caseous necrosis in thyroid tissue were found through postoperative histopathological evaluation. Polymerase chain reaction (PCR) results for Mycobacterium tuberculosis were positive in all patients. Most patients had a good prognosis after surgery and anti-tuberculosis drug therapy.CONCLUSION:PTT is a rare disease. It is important to improve the preoperative diagnosis. Preoperative diagnostic accuracy relies on increased awareness of the disease and appropriate use of preoperative diagnostic methods, such as PCR detection, fine-needle aspiration cytology, acid-fast bacillus culture, ultrasound and blood sedimentation. PCR detection of M. tuberculosis is recommended as the gold standard for diagnosis.

Pediatric AIDS-Therapeutic Successes Built on a Foundation of Pediatric Clinical Pharmacology with Pharmacokinetic-Pharmacodynamic Modeling.

Pediatric AIDS-Therapeutic Successes Built on a Foundation of Pediatric Clinical Pharmacology with Pharmacokinetic-Pharmacodynamic Modeling.

Pharmaceutical care model for antituberculosis drug therapy in tuberculosis patients at a primary healthcare centre in Surabaya, East Java, Indonesia

Background: Indonesia ranks third in the world for tuberculosis (TB), which remains a public health problem, where the role of health workers, including pharmacists, is needed. The role of pharmacists in primary health care centres is still limited to providing fixed-dose combination antituberculosis drugs (FDC) as a product. The provision of drugs as a means of therapy through pharmaceutical care in TB patients is still not optimal. Objective: This study aimed to create a pharmaceutical care model to improve adherence to FDC treatment regimens in TB patients at the primary health care centre. Methods: The study consisted of three stages, with the unit of analysis being pharmacist. The first stage was mapping the profile of FDC services in TB patients. The second stage was the creation of pharmaceutical care training modules. The third stage was testing the pharmaceutical care model with module training for pharmacists. The first stage of the study was an observational analytic cross-sectional design, including 63 pharmacists and 249 TB patients from July to September 2018. The third stage of the study was a quasi-experimental design with a pre-test post-test control group in October 2018, enrolling 36 pharmacists divided into 18 pharmacists in the intervention group and 18 pharmacists in the control group. The research was approved by the Health Research Ethics Commission, Faculty of Public Health, Universitas Airlangga. Results: The results consisted of a model of pharmaceutical care in TB patients. Pharmacists knowledge affects their abilities, including verification, explanation of indications, effectiveness, safety, and adherence. Pharmacists ability to influence patient response includes belief, understanding, expectation, concern, and adherence to the drug therapy regimen. Conclusion: The pharmaceutical care model improved adherence to the FDC therapy regimen in TB patients at the primary healthcare centre.

Validity of automated audiometry for hearing examination in patients with multidrug-resistant tuberculosis

Background: The objective of this study was to test the validity of automated audiometry as a method of hearing examination in patients with multidrug-resistant tuberculosis. Method s: This was a cross-sectional comparative study with a retrospective approach, using patient medical records. Patients with multidrug-resistant tuberculosis (MDR-TB) were recruited based-on medical records that met the inclusion and exclusion criteria at the Pulmonology outpatient unit, then referred to the Otorhinolaryngology outpatient unit of the Dr. Soetomo Academic Medical Center. The subjects’ hearing function was measured with two different devices (automated audiometer and conventional audiometer) before being given anti-tuberculosis drug therapy (aminoglycoside injection) as ototoxicity monitoring from July to December 2019 period. Sensitivity and specificity analysis was used to assess the validity of the test. Results: A total of 36 patients (72 ears) were included. The comparison test results using the Mann-Whitney test showed that there were significant differences between automated audiometry and conventional audiometry in both ears. Analysis values were: sensitivity 80-97%, specificity 37-96%, positive predictive value 74-98%, and negative predictive value 59-96%. Conclusion s: Automated audiometry is valid for use as a method of hearing examination and monitoring in patients with multidrug-resistant tuberculosis.

Glutathione-S-transferase genetic polymorphism and risk of hepatotoxicity to antitubercular drugs in a North-African population: A case-control study.

GST non-functional genotypes can lead to the accumulation of toxic intermediates, resulting in liver damage and increasing susceptibility to ATDH. To investigate the impact of GST Mu (GSTM1), GST Theta (GSTT1) null genotypes, and GST Pi (GSTP1; adenosine (A)>guanine (G), rs1695) variant allele on the development of ATDH in Tunisian patients treated with anti-tuberculosis therapy. This was a case-control study including patients receiving anti-tuberculosis regimen. Cases (n=23) were tuberculosis patients presenting ATDH during two months of anti-tuberculosis drug therapy. Controls (n=30) were patients treated for tuberculosis, but presenting no ATDH. Genotyping was performed using a polymerase chain reaction-restriction fragment length polymorphism. No statistically significant association was observed between GSTM1 and GSTT1 homozygous null genotypes, and the risk of ATDH. A statistically significant association between GSTM1 and GSTT1 double null genotypes, and the risk of ATDH was found (p=0.033) between cases and controls. For GSTP1, the distribution of GG homozygous mutant genotype was significantly associated with ATDH compared with the wild and the transition A to G (AA+AG) genotypes. Double deletion of GSTM1 and GSTT1 may predispose to ATDH in a Tunisian population. Moreover, GSTP1 rs1695 (A>G) genotyping can predict susceptibility to developing ATDH.

Association of deletion polymorphisms GSTT1 and GSTM1 with increased activity of hepatic transaminases in the blood of patients receiving anti-tuberculosis drug therapy

Association of deletion polymorphisms GSTT1 and GSTM1 with increased activity of hepatic transaminases in the blood of patients receiving anti-tuberculosis drug therapy

Tuberculous Meningitis in Children: Reducing the Burden of Death and Disability.

Tuberculous meningitis disproportionately affects young children. As the most devastating form of tuberculosis, it is associated with unacceptably high rates of mortality and morbidity even if treated. Challenging to diagnose and treat, tuberculous meningitis commonly causes long-term neurodisability in those who do survive. There remains an urgent need for strengthened surveillance, improved rapid diagnostics technology, optimised anti-tuberculosis drug therapy, investigation of new host-directed therapy, and further research on long-term functional and neurodevelopmental outcomes to allow targeted intervention. This review focuses on the neglected field of paediatric tuberculous meningitis and bridges current clinical gaps with research questions to improve outcomes from this crippling disease.

Validity of automated audiometry for hearing examination in patients with multidrug-resistant tuberculosis.

Background: The objective of this study was to test the validity of automated audiometry as a method of hearing examination in patients with multidrug-resistant tuberculosis. Method s: This was a cross-sectional comparative study with a retrospective approach, using patient medical records. Patients with multidrug-resistant tuberculosis (MDR-TB) were recruited based-on medical records that met the inclusion and exclusion criteria at the Pulmonology outpatient unit, then referred to the Otorhinolaryngology outpatient unit of the Dr. Soetomo Academic Medical Center. The subjects' hearing function was measured with two different devices (automated audiometer and conventional audiometer) before being given anti-tuberculosis drug therapy (aminoglycoside injection) as ototoxicity monitoring from July to December 2019 period. Sensitivity and specificity analysis was used to assess the validity of the test. Results: A total of 36 patients (72 ears) were included. The comparison test results using the Mann-Whitney test showed that there were significant differences between automated audiometry and conventional audiometry in both ears. Analysis values were: sensitivity 80-97%, specificity 37-96%, positive predictive value 74-98%, and negative predictive value 59-96%. Conclusion s: Automated audiometry is valid for use as a method of hearing examination and monitoring in patients with multidrug-resistant tuberculosis.

Successful Treatment of Cerebral Tuberculoma and Tuberculous Lymphadenitis in an HIV/AIDS Patient: A Case Report

Tuberculosis is one opportunistic infection that may occur in HIV/AIDS patients. Its clinical presentation may depend on infected organs. A 37-years old man complained of left limb weakness followed by mild fever, weight loss of more than 10 kgs within two months, and swelling in his left submandibular region. Laboratory tests showed mild anemia, hypoalbuminemia, and positive serology HIV test. Histopathological examination of neck swelling showed inflammation of chronic granulomatous tuberculous with acid-fast bacilli positive in Ziehl Nielsen staining. Head CT scan with contrast, showed multiple isodense lesions with rim contrast enhancement accompanied by perifocal edema. Anti-Tuberculosis Drug and Anti-Retroviral Therapy were given as a combination treatment for this patient. Clinical and radiological improvement in the patient indicated good outcome and successful treatment.