A RARE CASE REPORT: COMPARISON DIAGNOSIS OF MULTIDRUG-RESISTANT TUBERCULOSIS

FROM PLEURAL FLUID AND SPUTUM ON MOLECULAR RAPID TEST EXAMINATIONS

*Andi S. Gurning1, Indra Yovi1, Dewi Anggraini2, Dani Rosdiana3
1
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine,
University of Riau
2
Department of Clinical Microbiology, Faculty of Medicine, University of Riau
Arifin Achmad General Hospital Riau Province, Indonesia
3
Department of internal medicine, Faculty of Medicine, University of Riau
Arifin Achmad General Hospital Riau Province, Indonesia

Introduction
Multidrug-resistant pulmonary tuberculosis (MDR-TB) is a major health problem worldwide. Prompt diagnosis is
necessary for insuring appropriate therapy to lower morbidity and mortality, as well as to prevent disease
transmission.
Pleural effusion can occur due to an infectious process, one of which is caused by infection with mycobacterium
tuberculosis. MDR-TB originating from pleural fluid is a rare case called extra pulmonary multidrug resistant.

Case
A 49 years old Female hospitalized at Arifin Achmd general hospital with complaints of breathlessness, cough with
yellowish sputum,and right chest pain. The patient has a history of using anti-tuberculosis drugs for six months and
was declared cured. The patient is a housewife. On physical examination, the vesicular breath sound was weakened
in the right lung. On chest X-ray showed a right hydropneumothorax impression. Pleural punctures was performed
and WSD has been placed in patients. On the sputum examination, Mycobacterium tuberculosis was detected very
low and rifampicin resistance was not detected. However, on the molecular rapid test examination of pleural fluid
specimens, Mycobacterium tuberculosis was detected medium and rifampicin resistance also detected. Therefore
the patient was diagnosed with extrapulmonary MDR TB.

Before 1week 3 weeks Sputum sample Pleural fluid sample

Discussion
This patient had a history of taking anti-tuberculosis drugs with a history of cured medication. Then the patient comes with
complaints of shortness of breath, cough with yellowish phlegm. Suspicion of TB pleurits, then a rapid molecular test with
sputum specimens and pleural fluid is performed. Uniquely the sputum sample, MDR-TB results were not obtained, while the
pleural fluid samples obtained MDR-TB results.

Conclusion
In this case, the diagnosis of MDR-TB was found from pleural fluid. Molecular examination test from pleural fluid has
15-46% sensitivity and 98-99% specificity, but from sputum examination the result for MDR-TB is negative, so we
need more attention to diagnose MDR-TB, because is related for treatment.

References
1. Xu HB, Jiang RH, Li L.Pulmonary resection for patients with multidrugs-resistant tuberculosis systematical
review andmeta-analysis. J Clin Tuberc Other Mycobact Dis. 2020;66-95.
2. World Health Organization. Global tuberculosis report. Geneva,Switzerland: world Health Organization;2018