Diagnostic Dilemma

TB culture

A 6½ years old HIV infected girl on antiretroviral therapy {ART} for 1½ years consisting of Stavudine {d4T}, Lamivudine {3TC} and Nevirapine {NVP} presented with fever, vomiting and pain in abdomen for 2 months. For these complaints, a USG abdomen was done that showed mild hepatomegaly with matted lobulated hypoechoiec mass in left lumbar region. CT abdomen also showed extensive mesenteric and periaortic lymphadenopathy suggestive of tuberculosis {TB}. She was started on antituberculous therapy {ATT} consisting of Isoniazid {H}, Rifampicin {R}, Pyrazinamide {Z} and Ethambutol {E} along with steroids. She underwent an abdominal lump biopsy and pus smear showed presence of 5 acid fast bacilli {AFB}. However her TB culture after 6 weeks showed no AFB. On follow up after 3 months of ATT, her lump size had regressed from 7 cm to 4.3. Her CD4 count was 64 {11 percent}.

Why did the TB culture not grow AFB_?
Expert Opinion :
We have also consudered that cultures did not grow as it may be very little bacterial load.
Answer Discussion :
shanthi shanthi
Could it be atypical mycobacteriae_?
13 years ago
akila devic
att started might have destroyed the bacilli
13 years ago

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