Ben Ben Irwandi, Parluhutan Siagian
Departemen Pulmonologi dan Kedokteran Respirasi Fakultas Kedokteran Universitas Sumatera Utara, RSUP H. Adam Malik, Medan
Resistance to tuberculosis (TB) drugs is a formidable obstacle to effective TB care and prevention globally. Multi-drug resistant tuberculosis treatment which is exacerbated by multiple giant bullae dan empyema necessitans would add to the complexity of handling and affect the likelihood of failure or dropping out of high treatment and a lower quality of life. A 38 years old female with chief complain of shortness of breath since ± 6 months ago, history of smoking was found (IB:384, moderate), poor nutrition status (BMI: 15,96), history of antituberculosis treatment (ATT) was found category I in last year and others wise recovered, but she recurred and TB MDR diagnosed with Gene Xpert finding MTB Positive Rifampicine Resistant. Physical examination was found empyema necessitans in hemithorax sinistra. Chest x-ray showed hyperlucency avascular (giant bullae) in the uppers lobe of both lungs and air fluid level in the upper lobe of the left lung. Thoracic CT scan and mediastinal CT scan with contrast injection showed specific processes long been active with localized pneumothorax, bronchiectasis, and bilateral pleuritis. She has received TB MDR treatment regimen, but cycloserine is replaced by PAS. Treatment of TB MDR in the third edition of the ISTC and PMDT with evaluation and treatment failure need a change in treatment strategy. The patients get adequately regimen TB MDR and rigorous evaluation of the side effects. The clinical response to the treatment and investigation with a significant improvement and a better quality of life. Expected after sputum conversion, planned patient consul to the Department of thoracic and Cardiovascular Surgery. (J Respir Indo. 2017; 37: 69-74)
Keywords: Multiple giant bullae, empyema necessitans, PMDT, ISTC third edition.