DISSEMINATED MULTIDRUG-RESISTANT TUBERCULOSIS WITH EMPYEMA THORACIS, PSOAS ABSCESS, AND PARASPINAL ABSCESS IN AN IMMUNOCOMPETENT ADULT: A CASE REPORT

SESSION TITLE: Chest Infections Case Report Posters 9 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Multidrug-resistant tuberculosis (MDR-TB) is an emerging infectious disease caused by the Mycobacterium tuberculosis (MTB) organism resistant to at least Isoniazid and Rifampicin. It mostly affects the immunocompromised and is uncommon among immunocompetent adults.We present an unusual case of a 33-year-old, HIV-negative male diagnosed with MDR-TB with tuberculous empyema of the left hemithorax, psoas, and paraspinal areas who initially presented with cough, progressive leg weakness, and with an incidental right thumb lesion. CASE PRESENTATION: The patient initially presented with cough and shortness of breath. He did not report any history of fever, night sweats, weight loss, or a history of contact with any TB-infected patients. A 10-day course of antimicrobials was started and provided symptoms relief. He developed progressive leg weakness and low back pain which prompted further investigation. Chest radiograph demonstrated left lung pneumonia and pleural effusion. Sputum GeneXpert MTB assay was positive with indeterminate resistance to Rifampicin. Incidentally, an ulcerated, erythematous lesion with violaceous surroundings was found on the right 1st metacarpophalengeal joint. Wound GeneXpert MTB assay showed a positive result with Rifampicin resistance. Further work-up with Magnetic resonance imaging (MRI) of the spine showed empyema on the left lower hemithorax, left psoas muscle and right paraspinal area with associated spine compression. This prompted referral to Interventional Radiology and Computed tomography (CT) guided aspiration of abscesses with pigtail insertion were performed. The abscesses sent for analysis all yielded positive for MTB but with no resistance to Rifampicin. The final diagnosis was Multi-drug resistant Disseminated Tuberculosis. Second-line treatment for TB was initiated. The patient eventually improved and he underwent physical rehabilitation for conditioning. He was discharged clinically improved, all tubes removed, and ambulatory. DISCUSSION: TB infection is prevalent worldwide and is still a major cause of mortality and morbidity in developing countries such as the Philippines.The emergence of MDR-TB have become a public health threat as this disease is resistant to Isoniazid or Rifampicin, which are the main first-line drugs in treating TB. Detection requires bacteriological confirmation using rapid molecular tests, culture methods or sequencing prior to confirmation of the diagnosis.Adequate treatment for tuberculosis, both drug susceptible and drug resistant, is the major intervention for decreasing transmission of TB. However, treatment for MDR-TB is more difficult and requires drugs that cause more adverse reactions. Hence, closer monitoring and proper prescription is warranted. CONCLUSIONS: This case highlights the necessity for the early detection of MDR-TB by doing proper history taking and systematic investigation for a prompt diagnosis, effective treatment, and for the prevention of fatal outcomes. REFERENCE #1: Global tuberculosis report 2022. Geneva: World Health organization; 2022. licence: cc bY-Nc-sa 3.0 iGo. REFERENCE #2: Murray & Nadel, et al. Tuberculosis. Textbook of Respiratory Medicine. 7th edition. 2022. DISCLOSURES: No relevant relationships by Heidi Avediz Del Fuerte No relevant relationships by Nazario Macalintal