# Pre-extensively Drug-Resistant Pulmonary Tuberculosis With a Giant Primary Splenic Hydatid Cyst With Multiple Adverse Drug Reactions

## TL;DR

A rare case of drug-resistant tuberculosis combined with a large hydatid cyst in the spleen is reported, highlighting treatment challenges and side effects.

## Contribution

This is the first reported case of pre-extensively drug-resistant pulmonary tuberculosis co-occurring with a giant splenic hydatid cyst.

## Key findings

- The patient was diagnosed with pre-extensively drug-resistant pulmonary tuberculosis using nucleic acid amplification and drug susceptibility testing.
- A giant hydatid cyst was detected in the spleen through radiometric investigation.
- The patient experienced multiple adverse drug reactions during treatment.

## Abstract

Drug-resistant tuberculosis is a noteworthy threat to public health, especially in high-burden countries. Management of these types of tuberculosis is lengthy and associated with a number of adverse drug reactions. Pre-extensively drug-resistant tuberculosis is a serious type of disease that is caused by the strains of Mycobacterium tuberculosis that are resistant to either rifampicin or both, i.e., rifampicin and isoniazid, and resistant to any fluoroquinolones. A splenic hydatid cyst is relatively rare and has never been reported in a case of pre-extensively drug-resistant pulmonary tuberculosis. The present case is a rare case of a young Indian male who was diagnosed with pre-extensively drug-resistant pulmonary tuberculosis through a cartridge-based nucleic acid amplification test and second-line drug susceptibility testing. Further, a diagnostic radiometric investigation showed a giant hydatid cyst in the spleen. He was started on an all-oral longer treatment regimen per the existing protocols. However, his treatment was associated with multiple adverse drug reactions.