Vol. 47 No. (1) 154-159 (2020): Extrapulmonary Drug Resistant Tuberculosis in Zambia: Case Reports on the First Two Recorded Cases

Extrapulmonary drug resistant tuberculosis (DRTB)
is a rare manifestation of disseminated
tuberculosis which carries high mortality more so if
the central nervous system (CNS) is affected. This
paper reviews two cases of extrapulmonary DR-TB,
involving two males both aged 32 years and both
human immunodeficiency virus (HIV) positive. The
first case presented with fever and had meningeal
signs while the second case was a prisoner who
presented with recurrent anterior chest wall
abscesses respectively. The cerebrospinal fluid
(CSF) from the first patient and aspirate of the
abscess from the second patient were subjected to
nucleic acid amplification assays with Xpert®
MTB/RIF assay (Cepheid, CA, USA) and both
results showed mycobacterium positive, with
rifampicin resistance detected in low titers. Both
patients were initiated on all oral long regimen
containing bedaquiline (BDQ) and linezolid (LZD)
as core drugs. Both patients showed tremendous
improvement and were almost symptom free at
month three of treatment and had returned to full
functional status with no apparent adverse effects.
This shows the importance of high clinical
inquisition and the need for clinicians to subject
various bodily fluids to culture and molecular
testing including GeneXpert analysis.