First documented cure of a suggestive exogenous reinfection in polymyositis with same but multidrug resistant M. tuberculosis.
BACKGROUND
MDR Mycobacterium tuberculosis is the major cause of treatment failure in tuberculosis patients, especially in immunosuppressed. We described a young polymyositis patient on immunosuppressive therapy who was started with antituberculosis therapy as a susceptible strain of M. tuberculosis was isolated from a single cutaneous abscess in his neck and from regional lymph nodes.


METHODS
He had non-reactive miliary tuberculosis and multiple cutaneous abscesses 6 months later with the same strain, which was resistant this time to 9 antituberculosis drugs. We described clinical presentation, radiological and laboratory work-up, treatment and follow-up as the patient was cured after 1.5 years with 6 antituberculosis drugs.


CONCLUSIONS
To our knowledge, this is the first reported case where an immunosuppressed patient with suggestive exogenous reinfection within 6 months with the same but MDR strain of M. tuberculosis was cured. Intense management and regular follow up were important since the patient was a potent source of MDR M. tuberculosis infection and there was limited choice for therapy.
Mukhopadhyay
Chiranjoy
C
Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebarely Road, Lucknow, Uttar Pradesh, Pin: 226014, India. chiranjay@yahoo.co.in
Garg
Ankita
A
Ayyagari
Archana
A
D000038:Abscess / Q000188:drug therapy / Q000382:microbiology; D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics; D017931:DNA Primers / Q000737:chemistry; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D006801:Humans; D016867:Immunocompromised Host / Q000187:drug effects; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D016133:Polymerase Chain Reaction / Q000379:methods; D012150:Polymorphism, Restriction Fragment Length; D017285:Polymyositis / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D012008:Recurrence; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000382:microbiology; D014157:Transcription Factors / Q000235:genetics; D016896:Treatment Outcome; D014391:Tuberculosis, Miliary / Q000150:complications* / Q000188:drug therapy
D000995:Antitubercular Agents; D001426:Bacterial Proteins; D017931:DNA Primers; C098956:DevR protein, Nostoc; D007166:Immunosuppressive Agents; D014157:Transcription Factors