Management of Multidrug-resistant Tuberculosis in a Ukrainian Refugee with HIV/HCV Coinfection: A Case Report

Abstract

In this case study, we present a 53-year-old Ukrainian refugee with reactivation of multidrug-resistant tuberculosis, which was treated in Ukraine 4 years before he fled the country following the Russian invasion of Ukraine. The patient had a chronic HIV infection that had been treated with antiretroviral therapy and was newly diagnosed with severe acute respiratory syndrome coronavirus 2019 infection, hepatitis C infection and liver cirrhosis. Therefore, tuberculostatic therapy was individualized because of resistance against rifampicin, isoniazid, bedaquiline, and clofazimine and pre-existing liver cirrhosis and neuropathy. The latter was a sequela of a former tuberculosis treatment taken 4 years earlier. The treatment of the patient was complicated by superinfection of the lung cavity with carbapenemase-resistant Klebsiella pneumoniae and a life-threatening massive haemoptysis. He received a selective angiographic examination and bronchial artery embolization. This case report illustrates the complex management of several coinfections in the context of a humanitarian crisis following the on-going military conflict in Ukraine.