A 29-year-old Taiwanese man presented to the outpatient clinic at the Taipei Municipal Wanfang Hospital, Taipei City, Taiwan, having experienced a chronic productive cough and yellowish sputum for five months. Prior consultations with local medical doctors left the symptoms unresolved. He reported frequent travel to Southeast Asian countries. On visit, chest auscultation revealed scattered bilateral coarse crepitations, which were more prominent on the right side; his physical findings were otherwise unremarkable. Chest radiography revealed a right upper lung cavity. The computed tomography scan showed multiple enhancement of lymphadenopathies in the mediastinum. Three sputum smears were negative for acid-fast bacilli (AFB); however, sputum culture was positive for Mtb. The GenoType MTBDRplus assay (Hain LifeScience GmBH, Nehren, Germany) revealed rifampicin resistance (rpoB gene H526D mutation) and susceptibility to isoniazid.
The patient was treated with moxifloxacin, kanamycin, isoniazid, ethambutol, and pyrazinamide. The treatment course was uneventful and sputum culture was converted to negative on the second month of treatment. The patient was cured after 20 months of treatment, and serial follow-ups for two years showed no recurrence of TB (Figure 1).