GRAND ROUNDS AND TEACHING FILES
Pre-extensive drug resistant {XDR} Tuberculosis


You Have to Sign In First.
Click here to Sign In

Clinical Problem:


Ira Shah
Medical Sciences Department, Pediatric Oncall, Mumbai, India

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056


A 14 years old girl presented with low grade fever for 8 months along with loss of weight and appetite. She had received 3 drug antituberculous therapy {ATT} 2 years ago for 6 months in view of positive mantoux test. On examination, her weight was 28.2 kg, height was 148 cms. Systemic examination was normal. Chest X-Ray was normal. Ultrasound of abdomen showed multiple mesenteric lymph nodes with largest being 2 x 1.5 cm. CT abdomen showed multiple necrotic lymphnodes. CT guided biopsy of lymph node showed granulomas and tuberculosis {TB} culture did not grow mycobacterium tuberculosis {MTB}. She was started on 4 drug antituberculous therapy with 2 drugs as continuation phase. At end of 4 months of therapy, her weight was 32 kg but ultrasound showed increase in size of nodes to 3.6 cms. At end of 7 months of therapy, the nodes were the same but weight had increased to 37 kg. At end of 1 year of therapy, nodes had regressed in size {largest being 2.7 cm} and weight was 40.6 kg. ATT was stopped. After 3 months of stopping ATT, she presented with amenorrhea for 1½ months and fever for 15 days. She had achieved her menarche one year ago and menses were regular every 28 days. A repeat ultrasound abdomen was done that showed hypoechoic mass in right iliac fossa 6.8 cm x 2.8 x 2.0 cm adherent to the right ovary. A CT guided aspiration of the pus was done. She was started on IV ceftriaxone, metronidazole for the right tubo-ovarian mass along with medroxy progesterone for 5 days following which she had withdrawl bleeding. Her pus culture grew extended spectrum beta lactamase {ESBL} producing E.coli sensitive to carbapenems, amikacin, and colistin. She was shifted to IV Meropenem and fever responded to the same. TB culture after 6 weeks grew MTB resistant to isoniazid {H}, rifampicin {R}, pyrazinamide {Z}, ethambutol {E}, streptomycin {S} and moxifloxacin {Mfx} but sensitive to aminoglycosides, PAS, ethionamide and clofazimine.



What should be her ATT schedule now_?

Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.