Rifampicin-resistant tuberculosis remains a major global health challenge, particularly when occurring as primary resistance in patients without prior tuberculosis treatment. Tuberculosis drug resistance incidence in Indonesia expected 2.2% primary and 25% with prior anti-tuberculosis drug treatment. Resistance of Mycobacterium tuberculosis caused by spontaneous wild type chromosome mutation. Interaction between drug-resistance Tuberculosis and psychiatric disorder were underreported especially in developing countries. A 20-year-old female went to Emergency Department with malaise and clinically significant weight loss for the last one month. Fever, cough, and dyspnea were insidious. No prior medical history; lived in rural area with minimal ventilation. Laboratories shown moderate anemia, leukocytosis, and hypo-albumin. Sputum examination using the Xpert MTB/RIF assay detected Mycobacterium tuberculosis with rifampicin resistance. The patient was treated with rifampicin-resistant regimen and evaluated prior treatment with no contraindication. After three days of anti-tuberculosis treatment, patient experienced visual and auditory hallucination. Psychiatry examination conclude schizotypal personality disorder and anti-tuberculosis treatment was save to continue with adjunctive anti-psychotic treatment. After completing the rifampicin-resistant tuberculosis regimen, the patient demonstrated a favourable clinical outcome and was declared cured according to national tuberculosis program criteria. Diagnosis of primary rifampicin-resistant pulmonary tuberculosis is a rare diagnosis. During anti-tuberculosis treatment of rifampicin-resistant regimen, close monitoring and evaluation of patient symptoms especially psychiatric disorder should be done. Successful treatment could be achieved with multi discipline approach.
Amirullah et al. (Mon,) studied this question.