Lung India (Jan 2024)

A rare case of isoniazid mono-resistant tuberculosis presenting as cardiac tamponade along with an anterior mediastinal mass in a 15-year-old immunocompetent patient

  • Richa Mishra,
  • Ashima Jamwal,
  • Bishal Gupta,
  • Sudeep Kumar,
  • Abhijeet Bharali,
  • Parijat Das,
  • Alok Nath,
  • Manoj Jain,
  • Zafar Neyaz

DOI
https://doi.org/10.4103/lungindia.lungindia_221_23
Journal volume & issue
Vol. 41, no. 2
pp. 130 – 134

Abstract

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A 15-year-old boy presented with a sudden onset of breathlessness for 7 days, gradual loss of weight of 17.6 lbs over the last month and progressive hoarseness of voice for 7 months. The contrast-enhanced computed tomography (CECT) scan revealed a heterogeneously enhancing lesion in the anterior mediastinum with multiple discrete lymph nodes in the cervical and mediastinal locations. The GeneXpert MTB/RIF assay performed on the CT-guided biopsy of the mass was negative, but the culture for Mycobacterium tuberculosis was positive at 7 weeks of incubation. There was a suboptimal radiological response after 6 months of treatment. First-line drug susceptibility testing (DST) performed by line probe assay (LPA) on the positive culture detected high-level resistance to isoniazid. The treatment was modified as per DST results to which the patient responded well.

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