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Case Reports
. 2021 Dec 7;14(12):e245612.
doi: 10.1136/bcr-2021-245612.

Sterile tuberculous granuloma in a patient with XDR-TB treated with bedaquiline, pretomanid and linezolid

Pauline Howell  1 , Caryn Upton  2 , Nokuphiwa Mvuna  3 , Morounfolu Olugbosi  4
Affiliations
Case Reports

Sterile tuberculous granuloma in a patient with XDR-TB treated with bedaquiline, pretomanid and linezolid

Pauline Howell et al. BMJ Case Rep. .

Abstract

Drug-resistant tuberculosis (DR-TB) continues to pose a threat to the global eradication of TB. Regimens for extensively drug-resistant (XDR) TB are lengthy and poorly tolerated, often with unsuccessful outcomes. The TB Alliance Nix-TB trial investigated the safety and efficacy of a 26-week regimen of bedaquiline, pretomanid and linezolid (BPaL) in participants with XDR-TB, multidrug-resistant (MDR) TB treatment failure or intolerance. In this trial 9 out of 10 participants were cured. We describe a trial participant with XDR-TB who presented with new-onset seizures soon after BPaL treatment completion. Imaging showed a right temporal ring-enhancing lesion, and a sterile tuberculous granuloma was confirmed after a diagnostic, excisional biopsy. Learning points include management of a participant with a tuberculoma after BPaL completion, efficacy of new medications for central nervous system (CNS) TB and a review of their CNS penetration. This is the first case of pretomanid use in CNS TB.

Keywords: TB and other respiratory infections; drugs: CNS (not psychiatric); drugs: infectious diseases; infection (neurology); medical management.

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Conflict of interest statement

Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: PH: trial sponsor paid for article processing charges. Funding paid to institution for conduct of trial related research. CU: member of executive group for the SimpliciTB trial co-funded by TB Alliance (trial sponsor). Funding paid to institution for conduct of trial related research. NM: funding paid to institution for conduct of trial related research. MO: Employee of TB Alliance.

Figures

Figure 1
Figure 1
Chest X-ray showing bilateral diffuse nodular infiltrates with patchy consolidation in right upper and bilateral mid zones consistent with tuberculous pneumonia.
Figure 2
Figure 2
MRI of brain showing rim-enhancing lesion in the right temporal lobe measuring 11×15×11 mm (Anteroposterior×Transverse×Craniocaudal) with mild perilesional vasogenic oedema.
See this image and copyright information in PMC

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