Drug Resistant Extrapulmonary Tuberculosis: A Silent Assassin
Richmond R Gomes
ABSTRACT
Cervical-TB lymphadenitis is the most frequent extrapulmonary manifestation of tuberculosis infection. There are limited documents on multidrugresistant cervical tubercular lymphadenitis, but there is no evidence which may occur in TB endemic regions. Multidrug-resistant tuberculosis (MDR-TB) occurs when strains of Mycobacterium are resistant to the first-line anti-tuberculosis regimen. We present the case of a 23-year-old Bangladeshi male who presented to his primary care physician complaining of a two-month history of an enlarging neck mass. Aspiration of the mass, analysis revealed granulomatous inflammation suggestive of tuberculosis. Later he was lost to follow up. Later he again presented with fever and enlarging neck mass. Biopsy of the neck node followed by histopathology, Gene X-pert TB and line probe assay revealed Mycobacterium that was resistant to first-line anti-tuberculosis medications and levofloxacin. He was labelled as Pre XDR-EPTB (extensive drug resistant extra pulmonary tuberculosis). He was subsequently placed on second line anti-tuberculosis medications under specialized center.
