Clinical approach to drug-resistant tuberculosis of the brain and spine in a low-income setting: A case series.

BACKGROUND

Drug-resistant tuberculosis (TB) of the brain and spine is difficult to sample for culture. It poses a significant challenge to physicians in low- and middle-income countries.

METHODS

We present three patients of drug-resistant tuberculosis and demonstrate how we manage them in limited resources.

CASE SERIES: Multi drug-resistant (MDR1): a young female patient had cerebellar tuberculomas at presentation. While being on conventional antituberculous therapy (ATT), she developed meningitis, and deteriorated with impaired conscious-level. Later, patient sustained ischemic strokes. Second-line ATT improved her condition. Treatment course was complicated by peripheral neuropathy, and psychotic behavior.MDR2, a middle-aged woman having type-II diabetes was diagnosed with lumbar spondylitis. She was on conventional ATT for 1 year. Severe backache relapsed within a month of discontinuation of treatment. We started her on empirical second-line treatment. She had a dramatic response in pain and completely recovered at 1 year.MDR3, a middle-aged woman had spondylitic changes at D10-D11 vertebral bodies on magnetic resonance imaging. The pain showed sub-optimum response to conventional ATT. The hyperintense signal changes resolved at 1 year of treatment with levofloxacin and linezolid.

CONCLUSION

These outcomes will raise physicians' awareness of the need for early suspicion, and timely initiation of second-line therapy.