Tuberculosis of the urogenital and central nervous systems complicated with septic shock: lessons learned from a resource-limited setting
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Published version
Author(s)
Habiburrahman, M
Rakasiwi, MID
Type
Journal Article
Abstract
The incidence of tuberculosis (TB) infection in multiple organs outside the lungs is of particular concern. We present the case of a 48-year-old woman with a history of pulmonary TB who had a gradual loss of consciousness in one day, worsening shortness of breath, and a cough with green phlegm two weeks before admission. She had been undergoing five days of TB treatment with the drug-sensitive TB treatment regimen. The genital examination revealed a whitish mass in the paraurethral area, which impaired her urination. Blood gas analysis showed respiratory acidosis, and a chest X-ray suggested pulmonary TB and concurrent community-acquired pneumonia. She was diagnosed with extrapulmonary tuberculosis (EPTB) in the central nervous systems and urogenital sites. To treat her life-threatening EPTB, she received crystalloid infusions, oxygen supplementation, ampicillin-sulbactam (converted to meropenem the next day), an oral fixed-dose combination antituberculosis therapy, pyridoxine, N-acetylcysteine, ursodeoxycholic acid, Curcuma, bisoprolol, proton pump inhibitor, and antiemetics. Additionally, she was inserted with a urethral catheter and a nasogastric tube to assist her urination and nutritional intake. Our facility was a sub-district hospital and had a limited capacity for diagnosing and treating EPTB due to a lack of advanced intensive care units, blood and sputum cultures, and laboratory panels. After her two-day hospital admission to ICU for stabilisation, she was referred to a higher-level hospital with more advanced pulmonary treatment overseen by a multidisciplinary team. Our resource limitations highlight the importance of being well-informed about evidence-based primary EPTB management strategies.
Date Issued
2023-07-06
Date Acceptance
2023-04-12
Citation
Journal of Health and Translational Medicine, 2023, 26 (2), pp.94-100
ISSN
1823-7339
Publisher
University of Malaya
Start Page
94
End Page
100
Journal / Book Title
Journal of Health and Translational Medicine
Volume
26
Issue
2
Copyright Statement
All authors agree that the article, if editorially accepted for publication, shall be licensed under the Creative Commons Attribution License 4.0 to allow others to freely access, copy and use research provided the author is correctly attributed, unless otherwise stated. All articles are available online without charge or other barriers to access. However, anyone wishing to reproduce large quantities of an article (250+) should inform the publisher. Any opinion expressed in the articles are those of the authors and do not reflect that of the University of Malaya, 50603 Kuala Lumpur, Malaysia.
License URL
Identifier
https://jummec.um.edu.my/index.php/jummec/article/view/41499
Publication Status
Published
Article Number
114131
Date Publish Online
2023-06-22