Cerebral and bone multidrug resistant tuberculosis treated with the BPaLM regimen: case report

The BPaLM regimen is recommended for the treatment of pulmonary and extrapulmonary multidrug resistant tuberculosis, with the exception of cerebral and bone localization due to uncertainties on adequate drug concentrations in these tissues.

We report two MDR-TB cases with cerebral and bone disease treated with BPaLM at the Clinic of Infectious and Tropical Diseases in Brescia, Italy. Clinical data were collected through a comprehensive review of the electronic medical records, diagnostic results and patient interviews. The patients provided written informed consent for the publication of clinical data in anonymous form.

Patient 1, affected by disseminated TB involving lungs, lymph nodes and bones, completed 7 months of therapy, six of which with the BPaLM regimen, and demonstrated no evidence of relapse at 1-year follow-up. Patient 2, presenting with disseminated TB including cerebral and bone localisation, received the BPaLM regimen that was discontinued after 4 months due to adverse events.

Our report contributes to the limited clinical evidence on the use of BPaLM in cerebral and bone RR/MDR-TB. Of the two patients treated with this regimen, one did not complete therapy; however, treatment interruption was attributable to adverse events rather than lack of efficacy. Further evidence is urgently required on shorter regimens such as BPaLM for the treatment of extrapulmonary tuberculosis involving the brain and bones.