Dissemination of multidrug-resistant tuberculosis in a patient with acute HIV infection

Opportunistic infections are relatively rare in early human immunodeficiency virus infection, especially infection with Mycobacterium tuberculosis. Here, we report a patient who presented with acute human immunodeficiency virus and multidrug-resistant M. tuberculosis co-infections.

A 27-year-old homosexual male was admitted for fever, cough, and hepatitis. At the time of admission, the p24 antigen was detected in his serum, indicating that he had an acute human immunodeficiency virus infection. He was also diagnosed with disseminated tuberculosis spreading to the lung and skin. Anti-tuberculosis medication had been started earlier with one-week intervals of highly active antiretroviral therapy. Despite prolonged anti-tuberculosis treatment, the patient developed tuberculous meningitis on the 50th day of admission. Multidrug-resistant tuberculosis was cultured from his sputum and cerebrospinal fluid. The patient was successfully treated with second line anti-tuberculosis medication and antiretroviral treatment.

This is the first case of acute human immunodeficiency virus and multi drug-resistance tuberculosis co-infections. This case indicates that tuberculosis infection should be considered even in patients with acute human immunodeficiency virus infection.