Page 397 - Abstract Book KONIKA 18

Respirology

P-RES-014
Multidrug Resistant of Tuberculous Spondylitis:
A Case Report from Tertiary Hospital in Surabaya

Mellisa Kristanti Hosea, Muhammad Rizki Darmawan Mustakim, Rika Hapsari,
Arda Pratama Putra Chafid, Retno Asih Setyoningrum
Department of Child Health, Faculty of Medicine Universitas Airlangga/Dr. Soetomo General Academic Hospital,
Surabaya, East Java, Indonesia
Abstract
Background Tuberculous spondylitis is the most common form of extrapulmonary tuberculosis which
is around 50% of cases. Over the past two decades the emergence of multidrug-resistant tuberculosis
(MDR-TB) has steadily risen. The diagnosis of drug resistant TB spondylitis is often delayed resulting in
development of spinal deformity and neurological complications. Objective To overview the diagnosis of
MDR-TB spondylitis. Case A 15-years-old girl, had the main complain of back pain for 3 months. There
was swelling in the right flank, paresthesia and pain radiation to extremities. She had developed intermittent
fever and weight loss. She never had any history of tuberculosis examination before, and there was no close
contact with any tuberculosis patient. The lumbar spine x-ray showed bone destruction and bone shift of
th
th
the corpus of 4 -5 lumbal vertebrae. The patient was diagnosed as TB spondylitis and empirically given
the standard antituberculosis drug regimen. Percutaneous drainage of abscess was performed 1 month after
antituberculosis drug treatment, and Gen Xpert-MTB/RIF assay test of pus specimen inadvertently revealed
medium detected Mycobacterium tuberculosis and Rifampicin resistant. Acid Fast Bacillus (AFB) smear was
positive. Patient was diagnosed as MDR-TB spondylitis and got antituberculosis drug individual regimen and
planning for surgery, but family refused to take further medication. Conclusion The routine use of Xpert-
MTB/RIF examination and drug susceptibility testing (DST) in a suspected case of TB spondylitis appears
to be probable solution to know drug resistant in early stage of tuberculous infection.
Keywords: antituberculosis; multidrug resistant; spondylitis; tuberculosis; genXpert-MTB/RIF assay

P-RES-015
Miliary Tuberculosis (TB) in 3-month-old Infant: A Case Report

Muhammad Ali Syahrun Mubarok, Arda Pratama Putra Chafid, Rika Hapsari, Retno Asih Setyoningrum
Department of Child Health, Faculty of Medicine Universitas Airlangga/Dr. Soetomo General Academic Hospital,
Surabaya, East Java, Indonesia

Abstract
Background Miliary TB is a disease that can be fatal if not detected and treated early. Diagnosing miliary
TB might be difficult due to the lack of particular clinical signs and the fact that typical chest radiograph
findings may not appear until late in the disease. Objective To present a case of infant with miliary TB.
Case A 3-month-old infant was referred to the emergency department of Dr. Soetomo General Academic
Hospital with dyspnea and lethargy as his main symptom. He had been suffering from dyspnea for about two
weeks, and his breathing had been becoming worse three days before he was referred. He also developed an
intermittent fever about two weeks, followed with thrombocytopenia. His parents told he was immunized,
and TB contact was denied. He was diagnosed and treated for immune thrombocytopenic purpura in the
previous hospital. A symmetrical breath movement was observed on chest examination, as well as subcostal
and intercostal retraction and fine rhonchi over the lung region. On both lung fields, a chest X-ray revealed
reticulonodular shadowing. A BCG scar confirmed in the right deltoid. Tuberculin skin test showed no
induration, but a gastric aspirate GeneXpert detected Mycobacterium tuberculosis sensitive with rifampicin.
Conclusion To reduce the risk of complications and raise the survival rate in children with milliary TB, early
diagnosis and fast treatment are required.
Keywords: tuberculosis; miliary tuberculosis; TB; GeneXpert

KONIKA XVIII Abstract Book 349