Extrapulmonary Tuberculosis, Multidrug-resistant Tuberculosis and Diabetes Mellitus: Two Cases Highlighting the Need for Clinical Screening for Tuberculosis in Patients with Diabetes Mellitus

There is an increased burden of diabetes mellitus (DM) in resource poor setting, coupled with the susceptibility to co-infection with tuberculosis (TB) especially in a high endemic TB area. Programmatic re-engineering of screening for TB amongst patients with DM is needed to ensure a control of an ongoing silent coepidemic of DM and TB. We report two cases highlighting the importance of screening for TB among patients living with DM. Each case had a peculiar characteristic highlighting the role of TB screening and poor outcomes of TB in patients with DM. Case 1 is a 32-year-old nurse with uncontrolled DM, glycated haemoglobin of 16.1% on maximum dose of oral hypoglycaemic agents, who presented with night sweat, fever, weight loss, and left-sided chest pain of 2-week duration. She had a negative sputum GeneXpert for acid fast bacilli (AFB), and a chest radiograph was suggestive of left-sided pleura effusion which responded to TB treatment. Case 2 is a 45-year-old female with uncontrolled DM, who had associated complication of DM. She was diagnosed as pulmonary TB by sputum GeneXpert sensitive to rifampicin; however, by the 5th to 6th month of therapy, she presented with recurrent cough, fever and night sweat. Sputum AFB GeneXpert was positive for AFB but resistant to rifampicin. Undertaking TB screening among patients with DM in clinical practice needs to be intensified in order to improve the outcomes of both TB and control the epidemics.