Interdisciplinary management of multidrug-resistant tuberculosis in an HIV-infected patient: Case report

Abstract

Although the incidence of new tuberculosis (TB) cases in the general population is decreasing every year, the frequency of multi-drug-resistant TB is rising, especially throughout Eastern Europe, with the risk of further spread to other European counties. Nowadays, in the era of easy international travel, individualised exposure and drug response patterns need to be reviewed. Even in countries with small numbers of resistant Mycobacteria cases, MDR or XDR-TB should be considered, especially when there is a poor response to antituberculotic therapy. In the clinical practice, it is often necessary to include a surgical approach, with the excision of infectious tuberculomatous foci, supplementing tuberculostatic treatment. Treatment success is commonly dependent on such a combined approach. Such multidisciplinary care remains a significant and multifaceted problem, especially in poorer countries. In this paper, we present the case of a 46-year-old HIV-infected patient diagnosed with multidrug-resistant, multiorgan TB. The patient, of Polish nationality, previously working in Norway, presented in 2011 as newly diagnosed HIV-1 infection with a suspicion of TB. On admission, the patient's condition was severe with clinical features of wasting and symptoms of pulmonary and extrapulmonary TB infection. Standard treatment outcome was poor, with clinical response achieved only after confirmation of multidrug-resistant TB and optimisation of the therapy. Tuberculostatic treatment was supplemented with multiple surgical procedures, aimed at the diagnostics and allowing treatment of infectious foci. Therapy required complex management of two primary infections (HIV and TB) and multiple adverse-effects and coinfections that occurred during follow-up.