A complex case study: coexistence of multi-drug-resistant pulmonary tuberculosis, HBV-related liver failure, and disseminated cryptococcal infection in an AIDS patient.
Humans
Male
Middle Aged
Cryptococcosis
/ drug therapy
Tuberculosis, Pulmonary
/ drug therapy
Tuberculosis, Multidrug-Resistant
/ drug therapy
Liver Failure
/ virology
Acquired Immunodeficiency Syndrome
/ complications
Hepatitis B, Chronic
/ complications
Coinfection
/ drug therapy
Antitubercular Agents
/ therapeutic use
HIV Infections
/ complications
AIDS-Related Opportunistic Infections
/ drug therapy
AIDS
Disseminated cryptococcal disease
IRIS
Liver failure
MDR-PTB
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
27 May 2024
27 May 2024
Historique:
received:
30
06
2023
accepted:
24
05
2024
medline:
28
5
2024
pubmed:
28
5
2024
entrez:
27
5
2024
Statut:
epublish
Résumé
Hepatitis B virus (HBV) infection can cause liver failure, while individuals with Acquired Immunodeficiency Virus Disease (AIDS) are highly susceptible to various opportunistic infections, which can occur concurrently. The treatment process is further complicated by the potential occurrence of immune reconstitution inflammatory syndrome (IRIS), which presents significant challenges and contributes to elevated mortality rates. The 50-year-old male with a history of chronic hepatitis B and untreated human immunodeficiency virus (HIV) infection presented to the hospital with a mild cough and expectoration, revealing multi-drug resistant pulmonary tuberculosis (MDR-PTB), which was confirmed by XpertMTB/RIF PCR testing and tuberculosis culture of bronchoalveolar lavage fluid (BALF). The patient was treated with a regimen consisting of linezolid, moxifloxacin, cycloserine, pyrazinamide, and ethambutol for tuberculosis, as well as a combination of bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC) for HBV and HIV viral suppression. After three months of treatment, the patient discontinued all medications, leading to hepatitis B virus reactivation and subsequent liver failure. During the subsequent treatment for AIDS, HBV, and drug-resistant tuberculosis, the patient developed disseminated cryptococcal disease. The patient's condition worsened during treatment with liposomal amphotericin B and fluconazole, which was ultimately attributed to IRIS. Fortunately, the patient achieved successful recovery after appropriate management. Enhancing medical compliance is crucial for AIDS patients, particularly those co-infected with HBV, to prevent HBV reactivation and subsequent liver failure. Furthermore, conducting a comprehensive assessment of potential infections in patients before resuming antiviral therapy is essential to prevent the occurrence of IRIS. Early intervention plays a pivotal role in improving survival rates.
Sections du résumé
BACKGROUND
BACKGROUND
Hepatitis B virus (HBV) infection can cause liver failure, while individuals with Acquired Immunodeficiency Virus Disease (AIDS) are highly susceptible to various opportunistic infections, which can occur concurrently. The treatment process is further complicated by the potential occurrence of immune reconstitution inflammatory syndrome (IRIS), which presents significant challenges and contributes to elevated mortality rates.
CASE PRESENTATION
METHODS
The 50-year-old male with a history of chronic hepatitis B and untreated human immunodeficiency virus (HIV) infection presented to the hospital with a mild cough and expectoration, revealing multi-drug resistant pulmonary tuberculosis (MDR-PTB), which was confirmed by XpertMTB/RIF PCR testing and tuberculosis culture of bronchoalveolar lavage fluid (BALF). The patient was treated with a regimen consisting of linezolid, moxifloxacin, cycloserine, pyrazinamide, and ethambutol for tuberculosis, as well as a combination of bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC) for HBV and HIV viral suppression. After three months of treatment, the patient discontinued all medications, leading to hepatitis B virus reactivation and subsequent liver failure. During the subsequent treatment for AIDS, HBV, and drug-resistant tuberculosis, the patient developed disseminated cryptococcal disease. The patient's condition worsened during treatment with liposomal amphotericin B and fluconazole, which was ultimately attributed to IRIS. Fortunately, the patient achieved successful recovery after appropriate management.
CONCLUSION
CONCLUSIONS
Enhancing medical compliance is crucial for AIDS patients, particularly those co-infected with HBV, to prevent HBV reactivation and subsequent liver failure. Furthermore, conducting a comprehensive assessment of potential infections in patients before resuming antiviral therapy is essential to prevent the occurrence of IRIS. Early intervention plays a pivotal role in improving survival rates.
Identifiants
pubmed: 38802753
doi: 10.1186/s12879-024-09431-9
pii: 10.1186/s12879-024-09431-9
doi:
Substances chimiques
Antitubercular Agents
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
533Subventions
Organisme : Scientific Research Project of Hunan Public Health Alliance
ID : No. ky2022-002
Organisme : Scientific Research Project of Hunan Public Health Alliance
ID : No. ky2022-002
Organisme : Scientific Research Project of Hunan Public Health Alliance
ID : No. ky2022-002
Organisme : Scientific Research Project of Hunan Public Health Alliance
ID : No. ky2022-002
Organisme : Scientific Research Project of Hunan Public Health Alliance
ID : No. ky2022-002
Organisme : Scientific Research Project of Hunan Public Health Alliance
ID : No. ky2022-002
Organisme : Scientific Research Project of Hunan Public Health Alliance
ID : No. ky2022-002
Organisme : Scientific Research Project of Hunan Public Health Alliance
ID : No. ky2022-002
Informations de copyright
© 2024. The Author(s).
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