Tuberc Respir Dis.  2014 May;76(5):245-248. 10.4046/trd.2014.76.5.245.

Multidrug-Resistant Tuberculosis Presenting as Miliary Tuberculosis without Immune Suppression: A Case Diagnosed Rapidly with the Genotypic Line Probe Assay Method

• Ko Y
• Lee HY
• Lee YS
• Song J
• Kim MY
• Lee HK
• Shin JH
• Choi SJ
• Lee YM

• KMID: 1842972
• DOI: http://doi.org/10.4046/trd.2014.76.5.245

Abstract

Miliary tuberculosis (TB) is a rare extrapulmonary form of TB, and there have been only two reports of miliary TB associated with infection with multidrug-resistant (MDR)-TB pathogen in an immunocompetent host. A 32-year-old woman was referred to our hospital because of abnormal findings on chest X-ray. The patient was diagnosed with MDR-TB by a line probe assay and was administered proper antituberculous drugs. After eight weeks, a solid-media drug sensitivity test revealed that the pathogen was resistant to ethambutol and streptomycin in addition to isoniazid and rifampicin. The patient was then treated with effective antituberculous drugs without delay after diagnosis of MDR-TB. To the best of our knowledge, this is the first case of miliary TB caused by MDR-TB pathogen in Korea.

Keyword

Tuberculosis, Multidrug-Resistant; Tuberculosis, Miliary; Molecular Probe Techniques

MeSH Terms

Adult
Diagnosis
Ethambutol
Female
Humans
Isoniazid
Korea
Molecular Probe Techniques
Rifampin
Streptomycin
Thorax
Tuberculosis, Miliary*
Tuberculosis, Multidrug-Resistant*
Ethambutol
Isoniazid
Rifampin
Streptomycin

Figure

• 

  Figure 1 A 32-year-old woman diagnosed as military tuberculosis caused by multidrug-resistant pathogen. (A) Chest radiograph at the time of presentation showed diffuse micro-nodules involving both lung fields. (B) High-resolution computed tomography image (1.0 mm section thickness) revealed uniform-sized small nodules randomly distributed throughout both lungs.

• 

  Figure 2 Line probe assay results: for rifampicin, the strain revealed negative results of rpoB WT3 and WT4 probes, and positive result of rpoB MUT1 probe for D516V mutation; for isoniazid, there were missing band of katG WT and additional positive band in katG MUT1 for S315T1 mutation.

• 

  Figure 3 A chest radiography after treatment showed resolution of diffuse micro-nodules involving both lung fields.

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