Managing a case of extensively drug-resistant (XDR) pulmonary tuberculosis in Singapore

Abstract

Introduction: Extensively drug-resistant tuberculosis (XDR-TB) is an emerging global health risk. We present the first case report of XDR-TB in Singapore. Clinical Picture: A 41-year-old Indonesian lady with previously treated pulmonary tuberculosis presented with chronic cough. Her sputum was strongly acid-fast bacilli positive and grew Mycobacterium tuberculosis complex resistant to first and second-line TB medications. Treatment: She received 5 months of intensive multidrug treatment without sputum smear conversion. She then underwent resection of the diseased lung. The total cost incurred amounted to over S$100,000. Outcome: She achieved sputum smear/culture conversion post-surgery, but will require further medical therapy for at least 18 months. Conclusion: XDR-TB is poorly responsive to therapy and extremely expensive to manage. Its prevention by strict compliance to therapy is paramount.