Multifocal tuberculosis (bilateral pulmonary with cavitary lesions and intestinal involvement) in an adolescent from an MDR-TB

Abstract

Background. In the current alarming epidemiological conditions, the pediatric group is experiencing forms of tuberculosis characteristic of adults, extensive, complicated by destruction of the lung parenchyma and bronchogenic or hematogenous dissemination, aggravated by the presence of drug resistance to Anti-TB drugs. Objective(s). The aim of the paper is to present a clinical case of bilateral pulmonary and intestinal TB in an adolescent from the MDR-TB outbreak, requiring rigorous clinical surveillance in young people. Materials and methods. We studied the clinical case of an adolescent from an MDR-TB focus who was admitted to the Pediatric Department of the MC Phthisiopneumology Hospital on August 28, 2024. The diagnosis revealed multifocal tuberculosis: bilateral pulmonary involvement with cavitary lesions (CV), bronchogenic and hematogenous dissemination, and intestinal TB. Results. The patient, 18 years old, from a household outbreak of MDR-TB with his father, presented with chronic cough and hemoptysis. On 28.08.2024, the diagnosis was established: Bilateral infiltrative pulmonary TB (CV), Xpert MBT positive/Rif resistant, new case. BPaLM treatment was initiated (Bedaquiline, Pretomanid, Linezolid, Moxifloxacin), with sputum conversion by microscopy after 1 month of treatment. During the period 04- 10.10.2024, fever and signs of peritoneal irritation appeared. He underwent surgical treatment, being diagnosed with tuberculous peritonitis and secondary catarrhal appendicitis. Intestinal TB was confirmed bacteriologically. Conclusion(s). Pulmonary and extrapulmonary tuberculosis in young individuals with MDR-TB contact requires a high level of clinical suspicion and early intervention. A multidisciplinary approach and the use of modern therapeutic regimens such as BPaLM offer a real chance of disease control even in complex cases.