Work

Battling the odds, personalized pharmacotherapeutic approach in a difficult-to-treat DR-TB case with multiple comorbidities: a case report

Year: 2026

Type: article

Abstract: India, the capital of tuberculosis (TB) worldwide, accounts for 27% of the global burden of drug-resistant TB (DR-TB). Managing DR-TB in itself is challenging, and preexisting multiorgan dysfunction makes it even more lengthy and complex. Here, we share our real-world experience in successfully managing a difficult-to-treat case of rifampicin-resistant TB (RR-TB), a type of DR-TB, in a high-risk patient with multiple comorbidities. A 60-year-old 70 kg male diagnosed with RR-TB was referred from a District DR-TB Centre to our Nodal DR-TB Centre for pretreatment evaluation and treatment initiation in December 2022. Baseline evaluation revealed severe renal dysfunction, hepatic dysfunction, a prolonged QT interval, and poorly controlled diabetes mellitus, necessitating an individualized all-oral longer regimen with appropriate dose adjustments guided by the National Programmatic Management of Drug-resistant Tuberculosis Guidelines. During treatment, the regimen was sequentially individualized in response to evolving suspected adverse drug reactions, with each modification aimed at optimizing patient safety while maintaining an effective treatment regimen. The patient showed radiological improvement, achieved sputum culture conversion, and successfully completed the 18-month treatment by June 2024. The patient did not relapse during the 18-month follow-up period (December 2025). This case report exemplifies the success of personalized pharmacotherapeutic decision-making in challenging cases. Structured toxicity assessment and intensive clinical, laboratory, and electrocardiography monitoring in addition to timely treatment modification may facilitate successful treatment in carefully selected high-risk RR-TB patients when standard regimens are not feasible, even in resource-limited settings. Not applicable.

Source: BMC Infectious Diseases

DOI: 10.1186/s12879-026-14266-7

Authors: Sharwani Vijayshree Lal, Sudesh Kumari, Navjot Kaur, Anjleen Kaur, Jasbir Singh

Institution: Government Medical College

Language: English

Topic: Tuberculosis Research and Epidemiology

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,090