Multidrug-Resistant Tuberculosis in an Adult with Cystic Fibrosis

Abstract

&lt;i&gt;Mycobacterium tuberculosis&lt;/i&gt; infection in patients with cystic fibrosis (CF) is rare. We report a 22-year-old CF patient with high fever, dyspnea and weight loss that progressively worsened over 2 weeks before admission. The patient suffered from liver cirrhosis, was colonized with &lt;i&gt;Pseudomonas aeruginosa &lt;/i&gt;and had been repeatedly hospitalized for pulmonary infections. The patient was treated initially as for an exacerbation of &lt;i&gt;P. aeruginosa &lt;/i&gt;infection, but tuberculosis (TBC) was suspected due to lack of improvement. A CT of the chest revealed enlarged bilateral cavities in the upper and middle lobes. A tuberculin skin test was positive, and &lt;i&gt;M. tuberculosis&lt;/i&gt; nucleic acid was isolated from sputum samples. After receiving first-line anti-TBC drugs for 1 month, the patient's condition continued to worsen so molecular drug susceptibility testing was performed. Multidrug-resistant TBC was discovered, leading to a change in regimen. The patient was treated with ethionamide, moxifloxacin, linezolid, amikacin, imipenem/cilastatin and rifabutin and showed a remarkable clinical improvement. Although nontuberculous mycobacteria are more common in CF, the possibility of TBC should not be ignored. In that setting, early suspicion of infection due to resistant &lt;i&gt;M. tuberculosis&lt;/i&gt; can be life saving.</jats:p