A clinical case of an individual approach in the treatment of a patient with tuberculosis of the lungs and bronchus in combination with mycobacteriosis and Crohn's disease

Abstract

In the Russian Federation, there is an increase in patients with pulmonary tuberculosis in combination with comorbid pathologies, including Crohn's disease. There is also a tendency to increase the combination of pulmonary tuberculosis and non-tuberculosis mycobacteriosis, which makes it difficult to select adequate therapy and reduces the effectiveness of treatment. Bronchial tuberculosis is one of the complications of the tuberculosis process and often masks the onset of this disease. In this connection, the diagnosis of the tuberculosis process in the bronchi is difficult. A young patient with a history of Crohn's disease was diagnosed with pulmonary and bronchial tuberculosis in combination with non-tuberculosis mycobacteriosis. Upon admission, the presence of intoxication syndrome and bacterial excretion in sputum was noted. Taking into account the presence of comorbid pathology, anti-tuberculosis therapy was carried out according to an individual chemotherapy regimen with predominant parenteral administration of drugs. Against the background of the ongoing treatment, the patient noted the addition of a coronavirus infection with the development of viral pneumonia. Thanks to an individual approach in the treatment of the tuberculosis process in combination with non-tuberculosis mycobacteriosis and the presence of Crohn's disease, it was possible to achieve the relief of intoxication syndrome, the cessation of bacterial excretion in sputum and positive X-ray and endoscopic dynamics. This clinical example demonstrates the high effectiveness of an integrated approach in the treatment of tuberculosis in the presence of concomitant diseases. Due to the early endoscopic diagnosis, the patient revealed a tuberculous process in the bronchi. Given the presence of these diseases, complex chemotherapy was aimed at treating tuberculosis and mycobacteriosis simultaneously. Taking into account mainly parenteral administration of chemotherapy drugs, there was no exacerbation of Crohn's disease. The addition of coronavirus infection with the development of viral pneumonia did not affect the course of the tuberculosis process and non-tuberculosis mycobacteriosis.