Managing a case of extensively drug-resistant (XDR) pulmonary tuberculosis in Singapore.

INTRODUCTION

Extensively drug-resistant tuberculosis (XDR-TB) is an emerging global health risk. We present the first case report of XDR-TB in Singapore.

CLINICAL PICTURE

A 41-year-old Indonesian lady with previously treated pulmonary tuberculosis presented with chronic cough. Her sputum was strongly acid-fast bacilli positive and grew Mycobacterium tuberculosis complex resistant to first and second-line TB medications.

TREATMENT

She received 5 months of intensive multidrug treatment without sputum smear conversion. She then underwent resection of the diseased lung. The total cost incurred amounted to over S$100,000.

OUTCOME

She achieved sputum smear/culture conversion post-surgery, but will require further medical therapy for at least 18 months.

CONCLUSION

XDRTB is poorly responsive to therapy and extremely expensive to manage. Its prevention by strict compliance to therapy is paramount.