Disseminated multiorgan MDR-TB resistant to virtually all first-line drugs

• Published in: European respiratory review Vol. 18; no. 114; pp. 291 - 294
• Main Authors: Sasse, J, Teichmann, D
• Format: Journal Article
• Language: English
• Published: England Eur Respiratory Soc 01.12.2009; European Respiratory Society
• Subjects: Clinical infectious diseases; drug resistance; extensively drug-resistant tuberculosis; Humans; Male; multidrug-resistant tuberculosis; treatment; tuberculosis; Tuberculosis, Multidrug-Resistant - drug therapy; Young Adult
• ISSN: 0905-9180; 1600-0617
• DOI: 10.1183/09059180.00002109

Department of Infectious Diseases, Dresden-Neustadt Hospital, Dresden, Germany. CORRESPONDENCE: J. Sasse, Kyffhaeuserstr. 32, D-01309 Dresden, Germany. E-mail: joerg.sasse{at}gmail.com Received: April 8, 2009 Accepted June 4, 2009 ABSTRACT The emergence of multidrug-resistant tuberculosis (MDR-TB) is a major global concern since, despite a complex treatment regime, it still remains a lethal threat. A 21-yr-old male HIV-negative migrant from Burma presented with a disseminated tuberculosis affecting the lung, spleen, liver, mediastinal and abdominal lymph nodes. This particular strain of Mycobacterium tuberculosis proved to be resistant to all but one (pyrazinamide) of the first-line drugs, i.e. rifampicin, isoniazid and ethambutol, plus streptomycin, rifabutin and ofloxacin. On the mere account of its susceptibility concerning kanamycin it could not be labelled as extensively drug-resistant tuberculosis. After 1 month of a standard first-line four-drug regimen and a subsequent 4 months of second-line treatment with amikacin, moxifloxacin, terizidone, protionamide, linezolid and pyrazinamide, sputum cultures eventually yielded constantly negative results. Likewise, the organ manifestations decreased significantly, so as to be virtually undetectable in computed tomography scans after 1 yr of continuous treatment. A moderate pancytopenia reversed completely after dose adjustment of linezolid. Disseminated tuberculosis manifestations without typical pulmonary cavernous lesions are likely to represent primary infection rather than reactivation. Even a multiorgan disseminated MDR-TB with an extensive resistance pattern (including fluoroquinolones) can be successfully treated with an individual second-line treatment and result in considerably few adverse events. KEYWORDS: Clinical infectious diseases, drug resistance, extensively drug-resistant tuberculosis, multidrug-resistant tuberculosis, treatment, tuberculosis