Extensively drug resistant tuberculosis in a HIV-infected patient in a UK hospital.

Tuberculosis (TB) is a major cause of mortality in the HIV-infected population, with growing concern about increasing incidence in extensively drug-resistant (XDR) TB worldwide. We describe the first published case of XDR TB and HIV co-infection in the UK. The case describes a patient newly diagnosed with smear-positive pulmonary TB and HIV. The isolate was found to be XDR TB, requiring use of third-line TB drugs alongside antiretroviral medication, causing multiple complications due to drug toxicity and interactions. After culture conversion was achieved directly observed treatment with close community support was organized for the patient. Despite these arrangements the patient required readmission for new-onset headaches after poor adherence to treatment. Investigations confirmed lymphocytic meningitis. The patient eventually deteriorated and died from acute cerebral infarction. This case highlights the complexity of managing drug-resistant TB in HIV-infected individuals, due to difficult adherence, drug toxicity and potential public health risks.