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A Case of Disseminated Multidrug-Resistant Tuberculosis involving the Brain.

Jung EK, Chang JY, Lee YP, Chung MK, Seo EK, Koo HS, Choi HJ - Infect Chemother (2016)

Bottom Line: However, her headache and brain lesion worsened.Linezolid was added to intensify the treatment regimen, and steroid was added for the possibility of paradoxical response.Kanamycin was discontinued 6 months after initiation of the treatment; she was treated for 18 months with susceptible drugs and completely recovered.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

ABSTRACT
We report a case of a 23-year-old female immigrant from China who was diagnosed with multidrug-resistant tuberculosis affecting her lung and brain, resistant to the standard first-line therapeutics and streptomycin. She was treated with prothionamide, moxifloxacin, cycloserine, and kanamycin. However, her headache and brain lesion worsened. After the brain biopsy, the patient was confirmed with intracranial tuberculoma. Linezolid was added to intensify the treatment regimen, and steroid was added for the possibility of paradoxical response. Kanamycin was discontinued 6 months after initiation of the treatment; she was treated for 18 months with susceptible drugs and completely recovered. To our knowledge, this case is the first multidrug-resistant tuberculosis that disseminated to the brain in Korea.

No MeSH data available.


Related in: MedlinePlus

Clinical course of patients with disseminated MDR-tuberculosis.MTB, Mycobacterium tuberculosis ; B-MRI, brain MRI; B-CT, brain CT; TB, tuberculosis; PCR, polymerase chain reaction; INH, isoniazid; RFP, rifampin; CXR, chest X ray; IPM, imipenem; LVX, levofloxacin; MXF, moxifloxacin; AMK, amikacin; KAN, kanamycin; EMB, ethambutol; CCS, cycloserine; PTH, prothionamide; DMS, dexamethasone; LZD, linezolid; HD, Hospital day.
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Figure 4: Clinical course of patients with disseminated MDR-tuberculosis.MTB, Mycobacterium tuberculosis ; B-MRI, brain MRI; B-CT, brain CT; TB, tuberculosis; PCR, polymerase chain reaction; INH, isoniazid; RFP, rifampin; CXR, chest X ray; IPM, imipenem; LVX, levofloxacin; MXF, moxifloxacin; AMK, amikacin; KAN, kanamycin; EMB, ethambutol; CCS, cycloserine; PTH, prothionamide; DMS, dexamethasone; LZD, linezolid; HD, Hospital day.

Mentions: The result of conventional drug susceptibility testing was reported at the hospital day 71, which showed M. tuberculosis strain was resistant to RFP, INH, EMB, PZA, streptomycin and sensitive to amikacin, kanamycin, capreomycin, levofloxacin, moxicloxacin, ofloxacin, prothionamide, cycloserine, p-aminosalicylic acid and linezolid. Therefore, anti-TB medication was switched to kanamycin, prothionamide, cycloserine with moxifloxacin (Fig. 4).


A Case of Disseminated Multidrug-Resistant Tuberculosis involving the Brain.

Jung EK, Chang JY, Lee YP, Chung MK, Seo EK, Koo HS, Choi HJ - Infect Chemother (2016)

Clinical course of patients with disseminated MDR-tuberculosis.MTB, Mycobacterium tuberculosis ; B-MRI, brain MRI; B-CT, brain CT; TB, tuberculosis; PCR, polymerase chain reaction; INH, isoniazid; RFP, rifampin; CXR, chest X ray; IPM, imipenem; LVX, levofloxacin; MXF, moxifloxacin; AMK, amikacin; KAN, kanamycin; EMB, ethambutol; CCS, cycloserine; PTH, prothionamide; DMS, dexamethasone; LZD, linezolid; HD, Hospital day.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835434&req=5

Figure 4: Clinical course of patients with disseminated MDR-tuberculosis.MTB, Mycobacterium tuberculosis ; B-MRI, brain MRI; B-CT, brain CT; TB, tuberculosis; PCR, polymerase chain reaction; INH, isoniazid; RFP, rifampin; CXR, chest X ray; IPM, imipenem; LVX, levofloxacin; MXF, moxifloxacin; AMK, amikacin; KAN, kanamycin; EMB, ethambutol; CCS, cycloserine; PTH, prothionamide; DMS, dexamethasone; LZD, linezolid; HD, Hospital day.
Mentions: The result of conventional drug susceptibility testing was reported at the hospital day 71, which showed M. tuberculosis strain was resistant to RFP, INH, EMB, PZA, streptomycin and sensitive to amikacin, kanamycin, capreomycin, levofloxacin, moxicloxacin, ofloxacin, prothionamide, cycloserine, p-aminosalicylic acid and linezolid. Therefore, anti-TB medication was switched to kanamycin, prothionamide, cycloserine with moxifloxacin (Fig. 4).

Bottom Line: However, her headache and brain lesion worsened.Linezolid was added to intensify the treatment regimen, and steroid was added for the possibility of paradoxical response.Kanamycin was discontinued 6 months after initiation of the treatment; she was treated for 18 months with susceptible drugs and completely recovered.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

ABSTRACT
We report a case of a 23-year-old female immigrant from China who was diagnosed with multidrug-resistant tuberculosis affecting her lung and brain, resistant to the standard first-line therapeutics and streptomycin. She was treated with prothionamide, moxifloxacin, cycloserine, and kanamycin. However, her headache and brain lesion worsened. After the brain biopsy, the patient was confirmed with intracranial tuberculoma. Linezolid was added to intensify the treatment regimen, and steroid was added for the possibility of paradoxical response. Kanamycin was discontinued 6 months after initiation of the treatment; she was treated for 18 months with susceptible drugs and completely recovered. To our knowledge, this case is the first multidrug-resistant tuberculosis that disseminated to the brain in Korea.

No MeSH data available.


Related in: MedlinePlus