Multi-drug resistant extra-pulmonary tuberculosis in a HIV negative patient.

Sharma, S K; Mohan, A

Multi-drug resistant extra-pulmonary tuberculosis in a HIV negative patient.

Date

2004-01

Authors

Sharma, S K

Mohan, A

Abstract

A 25 year-old, HIV seronegative male presented with bilateral cervical lymphadenopathy with cold abscesses and sinus formation, peripancreatic lymphadenopathy and hypodense lesions in the spleen. Culture of pus aspirated from the cold abscess in the neck grew M.tuberculosis resistant to Rifampicin, Isoniazid, Ciprofloxacin and Para-aminosalicylic acid. In a resource-limited setting, he was treated with Ethambutol (E), Pyrazinamide (Z), Ethionamide (Eth), Cycloserine (Cyc), and Ofloxacin (Ofl). While on treatment, he developed drug induced hepatotoxicity; Z and Eth were stopped and clofazimine was added to the regimen. Subsequently, he developed splenic abscess and clofazimine induced generalized pigmentation of the body including tongue. After eighteen months of treatment, lymphadenopathy and splenic lesions regressed significantly. Thus, present case highlights several important basic principles of management of MDR-TB such as procuring tissue for microbiological testing, judicious use of imaging modalities, careful monitoring for adverse drug reactions, intercurrent infections and the need for pretreatment counselling for ensuring compliance and completion of treatment.

Keywords

Multidrug-resistant lymph node tuberculosis, drug induced hepatotoxicity, Clofazimine

Citation

Sharma S K, Mohan A. Multi-drug resistant extra-pulmonary tuberculosis in a HIV negative patient. Indian Journal of Tuberculosis. 2004 Jan; 51(1): 43-46.