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

  • Faradika Nopta Hadiatma ,
  • Erwin Astha Triyono ,


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.


  1. Kardjito T, Grange JM, Beck JS. Cooperative studies on the immunology of tuberculosis at Airlangga University, Surabaya, Indonesia. Asian Pac J Allergy Immunol. 1990;8(2):141-6.
  2. Putra ON, Yulistiani Y, Soedarsono S. Scoping review: QT interval prolongation in regimen containing bedaquiline and delamanid in patients with drug-resistant tuberculosis. Int J Mycobacteriol. 2022;11(4):349-55.
  3. Burhan E, Karyana M, Karuniawati A, Kusmiati T, Wibisono BH, Handayani D, et al. Characteristics of Drug-sensitive and Drug-resistant Tuberculosis Cases among Adults at Tuberculosis Referral Hospitals in Indonesia. Am J Trop Med Hyg. 2022;107(5):984-91.
  4. Winardi W, Wahyuni H, Hidayat M, Wirawan A, Uddin MN, Yusup M. Challenges on tuberculosis care in health care facilities during COVID-19 pandemic: Indonesian perspective. Narra J. 2022;2(2):e80.
  5. Bouros D, Tzouvelekis A. Extrapulmonary tuberculosis. In: Palange P, Rohde G, editors. ERS Handbook of Respiratory Medicine 2019. p. 886.
  6. Wulandari L. Tuberkulosa Paru. In: Marhana IA, Amin M, Permatasari A, Rosyid AN, editors. Buku Ajar Paru: Airlangga University Press; 2019.
  7. Chaudhary R, Bhatta S, Singh A, Pradhan M, Shrivastava B, Singh YI, et al. Diagnostic performance of GeneXpert MTB/RIF assay compared to conventional Mycobacterium tuberculosis culture for diagnosis of pulmonary and extrapulmonary tuberculosis, Nepal. Narra J. 2021;1(2):e33.
  8. Indonesian Minisrty of Health Decree. National Guidelines for Medical Treatment of Tuberculosis. Jakarta: Indonesian Minisrty of Health Decree. 2013.
  9. Putranti A, Asmarawati TP, Rachman BE, Hadi U, Nasronudin. Oral candidiasis as clinical manifestation of HIV/AIDS infection in Airlangga University hospital patients. IOP Conference Series: Earth and Environmental Science. 2018;125(1):012063.
  10. Ajmala I, Wulandari L. Terapi ARV pada Penderita Ko-Infeksi TB-HIV. Jurnal Respirasi. 2015;1(1):22-8.
  11. Purnomo W, Kusmiati T, Soedarsono S. Testicular Tuberculosis in an HIV Positive Patient Co-infection with Pulmonary Tuberculosis Mimicking Malignancy: A Case Report. Respiratory Journal. 2020;6(2):45-8.
  12. Signer D, Peterson S, Hsieh YH, Haider S, Saheed M, Neira P, Wicken C, Rothman RE. Scaling Up HIV Testing in an Academic Emergency Department: An Integrated Testing Model with Rapid Fourth-Generation and Point-of-Care Testing. Public Health Rep. 2016;131 Suppl 1(Suppl 1):82-9.
  13. Indonesian Ministry of Healt Decree. No. HK.01.07/MENKES/90/2019 National guidelines for medical services for the management of HIV; 2019.
  14. Nasrorudin. Infeksi HIV. In: Tjokroprawiro A, editor. Textbook of internal medicine Ed 2: Airlangga University Press; 2015.
  15. Djoerban Z, Djauzi S. Textbook of internal medicine 6th rev. In:Sudoyo AW, Setiyohadi B, Alwi I, Simadibrata M, Setiati S, editors. Jakarta: Internal Publishing; 2014.
  16. Fatimatuzzuhro, Sundari AS, Indriati DW. The Prevalence of Pulmonary Tuberculosis Among Newly Diagnosed HIV/AIDS Individuals Admitted in Gresik, Indonesia. Mal J Med Health Sci. 2020;16:4-8.
  17. Rathbun CR, Lockhart MS, Stephens RJ. Current HIV Treatment Guidelines - An Overview. Current Pharmaceutical Design. 2006;12(9):1045-63.
  18. Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015;36(42):2921-64.
  19. Maisch B, Soler S, Hatle L, Ristic D. Pericardial Disease. In: Camm AJ, Lüscher TF, Maurer G, Serruys PW, editors. The ESC Textbook of Cardiovascular Medicine: Oxford University Press; 2018.
  20. Bruchfeld J, Correia-Neves M, Källenius G. Tuberculosis and HIV Coinfection. Cold Spring Harb Perspect Med. 2015;5(7):a017871.
  21. Ntsekhe M, Shey Wiysonge C, Commerford PJ, Mayosi BM. The prevalence and outcome of effusive constrictive pericarditis: a systematic review of the literature. Cardiovasc J Afr. 2012;23(5):281-5.
  22. Senya BK, Anim NB, Domson BSK, Adu P. Prevalence of Asymptomatic Mycobacterium tuberculosis Infection in Charcoal Producers: A Cross-Sectional Study in Kaase, Ghana. J Pathog. 2018;2018:9094803.
  23. Willner DA, Goyal A, Grigorova Y, Kiel J. Pericardial Effusion. StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.
  24. Tulek NE. Pleural Tuberculosis. In: Sener A, Erdem H, editors. Extrapulmonary Tuberculosis: Springer Cham; 2019.
  25. Suryana K, Suharsono H, Antara J, Rai IBN. Effect of isoniazid preventive therapy on pulmonary tuberculosis activity in people living with HIV/AIDS at Wangaya hospital in Denpasar, Bali, Indonesia: a prospective cohort study. Bali Medical Journal. 2020;9(1):219–223.

How to Cite

Hadiatma, F. N., & Triyono, E. A. . (2023). A naive human immunodeficiency virus (HIV) patient with extrapulmonary tuberculosis manifestation: diagnosis and management challenges. Bali Medical Journal, 12(1), 319–323.




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