Case report

First documented cure of a suggestive exogenous reinfection in polymyositis with same but multidrug resistant M. tuberculosis

Chiranjoy Mukhopadhyay^1,2,3 , Ankita Garg⁴ and Archana Ayyagari⁵

¹  Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebarely Road, Lucknow, Uttar Pradesh, Pin: 226014, India

²  Current address: Department of Microbiology, Manipal College of Medical Sciences, P.O. Box 155, Deep Heights 16, Pokhara, Nepal

³  Corresponding address: Department of Microbiology, Manipal College of Medical Sciences, P.O. Box 155, Deep Heights 16, Pokhara, Nepal

⁴  Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebarely Road, Lucknow, Uttar Pradesh, Pin: 226014, India

⁵  Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebarely Road, Lucknow, Uttar Pradesh, Pin: 226014, India

author email corresponding author email

BMC Infectious Diseases 2004, 4:63doi:10.1186/1471-2334-4-63

Published:	23 December 2004

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.

Case presentation

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.

Conclusion

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.