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Sterile tuberculous granuloma in a patient with XDR-TB treated with bedaquiline, pretomanid and linezolid
  1. Pauline Howell1,
  2. Caryn Upton2,
  3. Nokuphiwa Mvuna1 and
  4. Morounfolu Olugbosi3
  1. 1Clinical HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Sandringham, South Africa
  2. 2TASK Applied Sciences, Cape Town, South Africa
  3. 3Global Alliance for TB Drug Development, Pretoria, South Africa
  1. Correspondence to Dr Pauline Howell; phowell{at}witshealth.co.za

Abstract

Drug-resistant tuberculosis (DR-TB) continues to pose a threat to the global eradication of TB. Regimens for extensively drug-resistant (XDR) TB are lengthy and poorly tolerated, often with unsuccessful outcomes. The TB Alliance Nix-TB trial investigated the safety and efficacy of a 26-week regimen of bedaquiline, pretomanid and linezolid (BPaL) in participants with XDR-TB, multidrug-resistant (MDR) TB treatment failure or intolerance. In this trial 9 out of 10 participants were cured. We describe a trial participant with XDR-TB who presented with new-onset seizures soon after BPaL treatment completion. Imaging showed a right temporal ring-enhancing lesion, and a sterile tuberculous granuloma was confirmed after a diagnostic, excisional biopsy. Learning points include management of a participant with a tuberculoma after BPaL completion, efficacy of new medications for central nervous system (CNS) TB and a review of their CNS penetration. This is the first case of pretomanid use in CNS TB.

  • drugs: infectious diseases
  • TB and other respiratory infections
  • medical management
  • drugs: CNS (not psychiatric)
  • infection (neurology)

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Footnotes

  • Contributors PH made substantial contributions to the conception of the work, the acquisition and interpretation of data for the work, drafted, revised, approved the work, and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CU made substantial contributions to the conception and drafting of the work, revised and approved the work, and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. NM made substantial contributions to the acquisition and interpretation of data for the work, revised and approved the work, and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MO made substantial contributions to the acquisition of data for the work, revised and approved the work, and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This study was funded by Bill and Melinda Gates Foundation (OPP1129600).

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests We have read and understood BMJ policy on declaration of interests and declare the following interests: PH: trial sponsor paid for article processing charges. Funding paid to institution for conduct of trial related research. CU: member of executive group for the SimpliciTB trial co-funded by TB Alliance (trial sponsor). Funding paid to institution for conduct of trial related research. NM: funding paid to institution for conduct of trial related research. MO: Employee of TB Alliance.

  • Provenance and peer review Not commissioned; externally peer reviewed.