Pulmonary tuberculosis with atypical presentation because of unknown previous HIV infection – case report

Abstract

Abstract Background People coinfected with tuberculosis (TB) and human immunodeficiency virus (HIV) are 20–37 times more likely to develop active TB disease than non-HIV-infected people. Syndemic interaction between HIV and TB epidemics has made testing for TB a must for HIV-infected people and vice versa. We present the case of a young male diagnosed with HIV infection, due to mandatory HIV testing for all TB cases in Romania. Case presentation A 30-year-old man was hospitalized for fever, chills and productive cough not influenced by previous antibiotic home treatment. He was admitted with tachycardia and bilateral presence of coarse crackles in lower pulmonary areas. Chest X-ray suggested bilateral bronchopneumonia; the results from blood tests showed inflammation, leukocytosis and anaemia. Hemocultures were negative. Under wide-spectrum antibiotic treatment, his general condition partially improved, but on the seventh day, chest X-ray revealed abscess in the left inferior lobe and the progression of previous lesions. Chest computed tomography revealed multiple large consolidation areas in both lung areas, a 13 cm diameter abscess and multiple mediastinal adenopathy of 2–4 cm in diameter. Acid fast bacilli smear from sputum was positive. After the diagnosis of pulmonary TB, anti-TB treatment was started; the patient was subsequently diagnosed with HIV infection. He received specific anti-TB treatment, and 3 weeks later, retroviral treatment was initiated. Clinical evolution was favourable and radiological appearance improved. In addition, he did not present any adverse effects of therapy. Conclusions HIV testing for all TB cases is a must because HIV-TB coinfection raises important diagnostic and treatment problems.