An integrated approach in the treatment of a patient with chronic destructive pulmonary tuberculosis with extensively drug-resistant pathogen

A clinical example demonstrating the need for a comprehensive approach in the treatment of patients with chronic tuberculosis and extensively drug-resistant pathogen is presented. The patient repeatedly had relapses of a specific process, despite ongoing anti-tuberculosis therapy for several years. During this period, drug resistance to the new anti-tuberculosis drug bedaquiline was formed, which significantly reduces the possibility of selecting adequate anti-tuberculosis therapy. In addition, the patient has a widespread tuberculous process of the trachea and bronchi, accompanied by massive bacterial excretion. Against the background of the complex treatment, by the 6th month of treatment, it was possible to achieve pronounced positive dynamics, however, a massive fibrous cavity remained in the right lung. Given the low functional parameters limiting the use of resection surgery, the patient was able to undergo collapsosurgical treatment in the form of extrapleural pneumonitis