BÁO CÁO CA LÂM SÀNG: THÀNH CÔNG CỦA PHÁC ĐỒ BPaL Ở BỆNH NHÂN LAO PHỔI TIỀN SIÊU KHÁNG (pre-XDR-TB) CÓ BMI THẤP

Abstract

Objective: The BPaL regimen (Bedaquiline, Pretomanid, and Linezolid) has been recommended by the World Health Organization for the treatment of pre-extensively drug-resistant tuberculosis (pre-XDR- TB). However, in Vietnam, this regimen is contraindicated in patients with a body mass index (BMI) <17 kg/m² due to concerns regarding potential toxicity. We report a case of pre-XDR pulmonary tuberculosis successfully treated with the BPaL regimen despite a markedly low BMI (body weight:33 kg, BMI= 13.67 kg/m²). Methods: Case report and literature review. Results: A 55-year-old male patient was diagnosed as relapsed case with pre-XDR pulmonary tuberculosis. The BPaL regimen was initiated with rigorous periodic monitoring. The patient demonstrated marked clinical improvement, and sputum conversion to negative was achieved by month 2 of treatment. However, anemia developed and progressed from grade 1 to grade 2 during months 6–7 of treatment, despite nutritional support and iron supplementation. Linezolid was discontinued at month 8, after which laboratory parameters gradually stabilized. The patient was classified as cured after a nine-month treatment period. Conclusion: This case suggests that the BPaL regimen may be effective in patients with very low BMI when accompanied by close monitoring and appropriate toxicity management. These findings provide additional evidence to reconsider the BMI <17 kg/m² contraindication currently specified in Vietnam’s national tuberculosis treatment guidelines.