A naive human immunodeficiency virus (HIV) patient with extrapulmonary tuberculosis manifestation: diagnosis and management challenges

Background: Co-infection of human immunodeficiency virus (HIV) and extrapulmonary tuberculosis (TB) is common tropical countries and could manifest with diverse clinical manifestations and mimic other diseases. This case report highlights the diagnosis and management challenges of a patient with HIV naive who had pleural and pericardial effusion manifestation due to extrapulmonary TB. Case presentation: A male 48 years old was referred with shortness of breath, cough with phlegm, fever with night sweats. The patient complained of chest tightness and pain, decreased appetite, and weight loss approximately 10 kg in the last six months. The patient had several times having sexual intercourse with prostitutes. White patches were presented on the tongue. The patient was tested twice with three methods for HIV test and yielded inconclusive results. The chest X-ray examination suggested left pleural effusion and echocardiography with the results of pericardial effusion. The patient had thoracentesis with the adenosine deaminase (ADA) test 52 U/L and the culture resulted a positive for Mycobacterium tuberculosis sensitive to rifampicin, isoniazid, ethambutol, and pyrazinamide. The patient was treated with anti-TB. Later, the viral load yielded a value of 1.43x10⁶ IU/mL and the patient was treated with antiretroviral therapy. Conclusion: Due to challenges of diagnose and manage of such co-infection with unusual clinical manifestations, multi-disciplinary approaches are required together with adequate healthcare facilities to support the diagnostics.