Deivasigamani Mohanakrishnan, Sureshgraham Dileepan, Srikanth Sruthi Priyadarsini, Santhalingam Balamurugan, Chokalingam Chandrasekar
Respiratory Medicine, ACS Medical College and Hospital, Chennai, IND.
Cureus. 2024 Aug 4;16(8):e66105. doi: 10.7759/cureus.66105. eCollection 2024 Aug.
Pulmonary tuberculosis (PTB), human immunodeficiency virus (HIV), and leprosy are of public health importance, as all three diseases are communicable and contribute to disease burden in society. Co-infection with these three entities is extremely rare but leads to significant mortality and morbidity. We report a case that highlights the diagnostic challenges and therapeutic management of a patient who was diagnosed with pure neuritic leprosy on multibacillary-multidrug therapy (MB-MDT) and subsequently co-diagnosed with PTB and HIV. The patient was started on anti-tubercular therapy and anti-retroviral therapy for treatment under India's national health programs, which play a major role in treating those of low socioeconomic status. The optimization of these therapeutic drugs is quite challenging during treatment due to potential drug interactions and toxicities. High clinical suspicion is required to rule out PTB before initiating rifampicin-containing MB-MDT, which can lead to rifampicin-resistant TB and screening for HIV. As there is a social stigma associated with these patients, they require good psychological support during and after treatment.
肺结核（PTB）、人类免疫缺陷病毒（HIV）和麻风病都具有公共卫生重要性，因为这三种疾病都具有传染性，并加重了社会的疾病负担。这三种病原体的合并感染极为罕见，但会导致显著的死亡率和发病率。我们报告了一例病例，该病例突出了一名患者的诊断挑战和治疗管理情况，该患者最初被诊断为纯神经炎型麻风病并接受多菌型多药疗法（MB-MDT），随后又被共同诊断为PTB和HIV。根据印度的国家卫生计划，该患者开始接受抗结核治疗和抗逆转录病毒治疗，这些计划在治疗社会经济地位较低的人群方面发挥着重要作用。由于潜在的药物相互作用和毒性，在治疗期间优化这些治疗药物颇具挑战性。在开始含利福平的MB-MDT之前，需要高度的临床怀疑以排除PTB，因为这可能导致耐利福平结核病，并需进行HIV筛查。由于这些患者存在社会耻辱感，他们在治疗期间和治疗后都需要良好的心理支持。
