TUBERCULOSIS OF THE UROGENITAL AND CENTRAL NERVOUS SYSTEMS COMPLICATED WITH SEPTIC SHOCK: LESSONS LEARNED FROM A RESOURCE-LIMITED SETTING
https://doi.org/10.22452/jummec.vol26no2.11
- Author:
Muhammad Habiburrahman
1
;
Muhammad Ilham Dhiya Rakasiwi
1
Author Information
1. Faculty of Medicine, Universitas Indonesia, Central Jakarta, DKI Jakarta 10430, Indonesia.
- Publication Type:Journal Article
- Keywords:
central nervous system tuberculosis;
extra-pulmonary tuberculosis;
granuloma of urethra;
genitourinary tuberculosis;
primary care
- MeSH:
Tuberculosis, Central Nervous System
- From:Journal of University of Malaya Medical Centre
2023;26(2):94-100
- CountryMalaysia
- Language:English
-
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 lifethreatening 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 subdistrict 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 evidencebased primary EPTB management strategies.
- Full text:2025082111361962363114131.pdf
