Disseminated multiorgan MDR-TB resistant to virtually all first-line drugs

The emergence of multidrug-resistant tuberculosis (MDR-TB) is a major global concern since, despite a complex treatment regime, it still remains a lethal threat. A 21-yr-old male HIV-negative migrant from Burma presented with a disseminated tuberculosis affecting the lung, spleen, liver, mediastinal and abdominal lymph nodes. This particular strain of Mycobacterium tuberculosis proved to be resistant to all but one (pyrazinamide) of the first-line drugs, i.e. rifampicin, isoniazid and ethambutol, plus streptomycin, rifabutin and ofloxacin. On the mere account of its susceptibility concerning kanamycin it could not be labelled as extensively drug-resistant tuberculosis. After 1month of a standard first-line four-drug regimen and a subsequent 4months of second-line treatment with amikacin, moxifloxacin, terizidone, protionamide, linezolid and pyrazinamide, sputum cultures eventually yielded constantly negative results. Likewise, the organ manifestations decreased significantly, so as to be virtually undetectable in computed tomography scans after 1yr of continuous treatment. A moderate pancytopenia reversed completely after dose adjustment of linezolid. Disseminated tuberculosis manifestations without typical pulmonary cavernous lesions are likely to represent primary infection rather than reactivation. Even a multiorgan disseminated MDR-TB with an extensive resistance pattern (including fluoroquinolones) can be successfully treated with an individual second-line treatment and result in considerably few adverse events.