Hepatic and splenic tuberculosis in a patient with severe immunosuppression and neurological complications

摘要

Introduction: Mycobacterium tuberculosis can be located in every organ of the human body developing specific tuberculosis histopathological aspects. Hepatic and splenic tuberculosis may be suspected in immunocompromised patients with hepatomegaly and splenomegaly, fever and elevated liver enzymes. Diagnosis is confirmed by culture of a pathological sample or by histological examination of a biopsy of the affected tissue or organ for M. tuberculosis.Case report: 21 years old female known with HIV Infection Category C3 (CD4 -10 cells mm3), treated with antiretroviral therapy (ART) since November 2014, diagnosed in January 2015 with Progressive Multifocal Leukoencephalopathy, tetra-ataxia, tetra paresis and secondary epilepsy with repeated admissions to an Infectious Department of our hospital for prolonged febrile syndrome, nausea and weight loss is thoroughly investigated for hepatosplenic abscesses identified by CT-scan.In May 2015 a liver biopsy performed in a Hospital in Bucharest and Real Time PCR identified M. tuberculosis 610,000 copies ml and Rifampicin resistance gene present. Culture confirmed M. tuberculosis.Extended DST (after 60 days) revealed sensitivity just for Ethionamide – tuberculosis XDR (extensively resistant). Initial treatment with tuberculosis drugs according to regimen WHO category 1 was individualized for the identified resistances. ART was also modified because of resistance to Rifampicin. Her condition slowly improved with fever remission and improvement of biological inflammatory syndrome and neurological manifestations associating physical therapy and specialized treatment.Conclusions: Extremely rare and very serious case of XDR TB with atypical localizations due to marked immunodeficiency. It represents a therapeutic challenge involving a multidisciplinary team and prolonged admissions in many specialized departments.