DR-TB Case Series: Destroyed lung - Chronic pulmonary MDR-TB

The patient is a 67-year-old man who was initially referred to your clinic about six months ago because of an abnormal chest X-ray. He has a history of treatment for tuberculosis in the distant past on three separate occasions. He cannot remember specific details about the regimens except that he only received tablets—no injections.

Smear microscopy at the initial evaluation was positive. Culture and drug susceptibility test results returned four weeks later showing resistance to isoniazid, rifampin, ethambutol, and pyrazinamide but susceptibility to levofloxacin and amikacin. The patient was started on MDR-TB treatment at that time. He converted his sputum to smear negative after four months of treatment. Sputum culture from month three was positive but most recent sputum culture from month four is pending.

On evaluation today during the fifth month of treatment, he feels well.  He has no fever or cough. He has gained three kilograms since the commencement of treatment. He has had some complaints of nausea that improved upon discontinuation of pyrazinamide three months into treatment because confirmatory testing suggested pyrazinamide resistance.

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