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Drug-Resistant (DR) Tubercular Pleural Effusion: A Rare Case
Juhi Kadukar1, Gaurang M Aurangabadkar2, Pankaj Wagh1
1Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND.
Cureus
|December 12, 2022
Summary
Diagnosing drug-resistant tuberculosis pleural effusion is challenging. This case highlights successful management of multidrug-resistant tubercular pleural effusion using advanced diagnostics and a bedaquiline-containing regimen.
Area of Science:
- Pulmonology
- Infectious Diseases
- Microbiology
Background:
- Tuberculosis (TB) remains a global health challenge, particularly in developing nations.
- Drug-resistant (DR) TB cases are increasing, complicating treatment strategies.
- Diagnosing tubercular pleural effusion is difficult due to low bacillary load and unreliable Ziehl-Neelsen staining.
Observation:
- A patient presented with symptoms suggestive of extra-pulmonary TB, initially misdiagnosed as drug-sensitive.
- Conventional anti-tubercular therapy for two months yielded no improvement.
- Pleural fluid analysis revealed exudative effusion with elevated adenosine deaminase (ADA) levels.
Findings:
- Advanced molecular diagnostics, including Xpert® MTB/R assay and Line Probe Assay (LPA), identified R- and H-resistant tubercular effusion.
- Drug sensitivity testing (DST) confirmed multidrug-resistant (MDR) tuberculosis.
- The patient showed significant improvement after initiating an oral bedaquiline-containing regimen.
Implications:
- This case underscores the importance of advanced diagnostics for accurate TB diagnosis, especially in drug-resistant cases.
- Bedaquiline-containing regimens offer a promising treatment option for multidrug-resistant tubercular pleural effusion.
- Improved diagnostic and treatment strategies are crucial for combating the rise of drug-resistant TB globally.
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