Pulmonary tuberculosis and severe malnutrition: A case in a young man in El Alto at 4150 meters above sea level

We present the case of a 19-year-old male patient with pulmonary tuberculosis and severe malnutrition, resident at 4150 masl in El Alto, La Paz, Plurinational State of Bolivia. The clinical case included abdominal pain, dyspnoea, weight loss, nocturnal diaphoresis, lower limb oedema and anaemia. Laboratory tests revealed severe anaemia, leucopenia, thrombocytopenia and hypoalbuminaemia, with positive serial sputum smear microscopy with high bacillary load. Chest X-ray and CT scan showed bilateral alveolar infiltrates and pulmonary microcavitations. Intensive antituberculosis treatment with isoniazid, rifampicin, pyrazinamide and ethambutol was started, along with nutritional support and oxygen therapy, achieving complete clinical recovery and negative sputum smear tests. This case highlights the bidirectional interaction between tuberculosis and malnutrition in a context of chronic hypoxia associated with high altitude, highlighting the need for multidisciplinary approaches in high altitude settings.