Clinical course of extensively drug-resistant tuberculosis with HIV infection and tertiary syphilis: a case report

• Main Authors: O. M. Raznatovska, A. V. Fedorets, O. O. Furyk, H. I. Makurina, T. O. Hrekova, V. V. Romashchenko
• Format: Article
• Language: English
• Published: Zaporozhye State Medical University 2019-12-01
• Series: Patologìâ
• Subjects: tuberculosis; hiv; syphilis
• Online Access: http://pat.zsmu.edu.ua/article/view/189001/189450

Purpose. To update the literature data with the clinical features of extensively drug-resistant tuberculosis (XDR-TB), HIV and tertiary syphilis co-infection course based on an example from own clinical experience. Materials and methods. A case report of XDR-TB with HIV and tertiary syphilis co-infection course was described based on our own clinical experience. Results. The presented clinical case confirms the partial literature data as we did not find such a combined course of XDR-TB with HIV infection and tertiary syphilis in the literature available. So, XDR-TB developed in the patient due to late diagnosed and untreated HIV infection. Neurosyphilis praecox developed secondary to Lues latens ignorata. Early diagnosis of tertiary syphilis was problematic owing to considerable similarity of XDR-TB and HIV infection clinical manifestations. The CD4+ T-lymphocyte count was 16 cells (with a viral load of 3483783 RNA copies/ml) indicating a pronounced immune system inhibition in the patient, causing progressive multiple organ failure, HIV-associated diseases (nephropathy, encephalopathy, cardiomyopathy) and visceral tertiary syphilis (the kidney and brain). Despite multimodality therapy (antimycobacterial, antiretroviral, symptomatic and pathogenetic therapy, treatment of syphilis), the patient died after 4 months of inpatient treatment. The immediate causes of death were wasting syndrome, mycobacteriosis, HIV infection-associated diseases manifested as mycobacterial infection and multiple diseases. Conclusions. Taking into account the considerable similarity of clinical and histological manifestations of tuberculosis and syphilis, as well as frequent HIV-associated tuberculosis (especially CRTB), it is recommended not to neglect the continuous use of a serological panel in patients with HIV and tuberculosis co-infection with the view to timely syphilis detecting. General practitioners are encouraged to work with patients towards the timely HIV testing. Also, it should be kept in mind that timely diagnosed diseases could be treated early, that will help save lives of our patients.