title: First documented cure of a suggestive exogenous reinfection in polymyositis with same but multidrug resistant M. tuberculosis.
abstract: 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.
authors.affiliation: Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebarely Road, Lucknow, Uttar Pradesh, Pin: 226014, India. chiranjay@yahoo.co.in
authors.forename: Chiranjoy
authors.initials: C
authors.lastname: Mukhopadhyay
authors.forename: Ankita
authors.initials: A
authors.lastname: Garg
authors.forename: Archana
authors.initials: A
authors.lastname: Ayyagari
mesh_terms: 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
chemical_list: D000995:Antitubercular Agents; D001426:Bacterial Proteins; D017931:DNA Primers; C098956:DevR protein, Nostoc; D007166:Immunosuppressive Agents; D014157:Transcription Factors