Primary bedaquiline-resistant tuberculosis in an Afghan migrant to Switzerland: Diagnostic and treatment challenges in a high-resource setting.
Nasstasja Wassilew, Anna Eichenberger, Cornelia Staehelin et al.
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Case in brief
A young Afghan asylum seeker in Switzerland presented with chronic dry cough, weight loss, and small upper-lobe nodular lesions after a history of pulmonary tuberculosis treatment. Diagnosed with rifampicin mono-resistant tuberculosis, he was started on BPaLM. However, resistance to bedaquiline and clofazimine was later confirmed. An individualized treatment regimen led to clinical and radiological improvement, and the patient remains well 1.5 years post-treatment.
What made this case unusual
The case illustrates primary bedaquiline resistance in a patient who had never been treated with the drug, highlighting the complexities of managing drug-resistant tuberculosis.
Diagnostic / clinical pearl
Clinicians should consider the possibility of primary bedaquiline resistance in patients with a history of tuberculosis, even if they have not previously received the drug.
Why it matters
This case underscores the need for improved diagnostic methods to quickly identify bedaquiline-resistant tuberculosis, ensuring timely and effective treatment.