BMJ Case Reports 2012; doi:10.1136/bcr.02.2010.2775
  • Reminder of important clinical lesson

Multidrug-resistant tuberculosis that required 2 years for diagnosis

  1. Toshikazu Ikeda
  1. National Hospital Organization Matsue Medical Centre, Matsue, Japan
  1. Correspondence to Dr Shuichi Yano, yano{at}


Isoniazid (H) or rifampicin (R) mono-resistant disease can be treated easily and effectively with first-line drugs, while combined H and R resistance (ie, multidrug-resistant tuberculosis (MDRTB)) requires treatment with at least four agents, including a quinolone and an injectable agent. Drug-resistant Mycobacterium tuberculosis strains are reported to be extremely difficult to cultivate invitro. The authors report a case of MDRTB that required 2 years for diagnosis, and was detected only in sputum culture on solid medium. Physicians should consider MDRTB if TB is suspected but pathogens are not detected.


  • Competing interests None.

  • Patient consent Obtained.

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