Beyond the pill count: unmasking the pharmacokinetic drivers of recurrent tuberculosis.
Arti D Shah, Neha Garg, Bhavesh M Patel et al.
✦ AI-curated · Sources linked
Case in brief
A young adult female with recurrent sputum smear-positive pulmonary tuberculosis presented with worsening breathlessness, productive cough, and intermittent fever. Imaging revealed bilateral upper lobe fibrocavitary disease with cystic bronchiectasis. Despite prior treatments, therapeutic drug monitoring revealed undetectable rifampicin and subtherapeutic isoniazid levels. After adjusting her regimen and providing nutritional support, she experienced significant improvement after six months.
What made this case unusual
The case highlights the use of therapeutic drug monitoring in a patient with recurrent drug-sensitive tuberculosis, which is not routinely recommended in standard management.
Diagnostic / clinical pearl
Clinicians should consider therapeutic drug monitoring in cases of recurrent tuberculosis to identify potential pharmacokinetic issues affecting treatment efficacy.
Why it matters
This case underscores the need to explore alternative causes of treatment failure in tuberculosis, particularly in patients with a history of recurrent disease.