Miliary Pulmonary TB with Oral Thrush et causa HIV; Case Report


  • Hariz Ghulam Ramadhan Universitas Lampung
  • Lucky Togihon Bagian Kedokteran Paru dan Respirasi, RSUD DR. H. Abdoel Moeloek Bandar Lampung



Antiretrovirals, Human immunodeficiency virus (HIV), Fixed Drug Combination (FDC), Tuberculosis


Tuberculosis (TB) is a leading cause of morbidity and mortality among HIV-infected patients while HIV remains one of risk factor for the development of active TB infection. In infected individuals, Mycobacterium tuberculosis and HIV accelerate the decline in immunological function. Treatment integration is a key in reducing mortality in patients with HIV-TB co-infection. This case report discusses a 22-year-old male patient who experienced chronic cough, chronic dyspnea, intermittent fever, malaise, night sweats, decreased appetite and weight loss. The patient has a history of free sex and a history of pulmonary tuberculosis in his mother. The results of the physical examination, a white membrane was found on the cheek mucosa and on the surface of the patient's tongue indicating the presence of oral thrush and there were coarse wet crackles in both lung fields of the patient. From the results of supporting examinations, a chest X-ray impression of miliary pulmonary TB, GeneXpert MTB/rifampicin sputum results, positive MTB with sensitivity to rifampicin, and reactive Anti-HIV results. So that from the results of the history, physical examination, and supporting examinations in this patient, the diagnosis is miliary pulmonary TB with oral thrush et causa HIV. This patient was given pharmacological treatment 4 Fixed Drug Combination (FDC) 2 tablets/day, N-Acetylcysteine 200 mg 3 times a day, Co-trimoxazole 960 mg 1 time a day and vit B6 25 mg 1 time a day. Antiretroviral therapy (ARV) can given in 2- 8 weeks after OAT therapy. Monitoring was carried out after 2,5, and 6 months of treatment through the results of sputum smear examination and chest X-ray. The most important side effect that needs to be evaluated in patients is Immune Reconstitution Inflammatory Syndrome (IRIS).The patients had good vital signs and reasonable OAT side effects.


World Health Organization. Global tuberculosis report 2018. Geneva: WHO; 2018.

Ministry of Health Republic of Indonesia. Situation Report on the development of HIV/AIDS and other infectioouos disease in Indoonesia in 2021. Directorate General of Disease Control and Environmental Health; 2022.

Teweldemedhin M, Asres N, Gebreyesus H, Asgedom SW. Tuberculosis-Human Immunodeficiency Virus (HIV) co-infection in Ethiopia: a systematic review and meta-analysis. BMC infectious diseases. 2018 Dec;18(1):1-9.

Aung MN, Moolphate S, Paudel D, et al. Regional Review Global Evidence Directing Regional Preventive Strategies in Southeast Asia for fighting TB/HIV. The Journal Infection Developing Countries. 2013; 7(3): 1912202.

Lolong DB, Simarmata OS, Novianti, Senewe FP. Situasi Human Immunofeficiency Virus-Tuberkulosis di Kabupaten Merauke 2018: Ancaman pada Umur Produktif. Jurnal Kesehatan Reproduksi. 2019; 10(1): 109.

Naidoo K, Baxter C, Abdool Karim SS. When to start antiretroviral therapy during tuberculosis treatment? Curr Opin Infect Dis 2013; 26 : 35-42.

Perhimpunan Dokter Paru Indonesia. Panduan Umum Praktik Klinis Penyakit Paru dan Pernapasan. Jakarta: PDPI 2021

Bell LCK and Noursadeghi M. Pathogenesis of HIV-1 and Mycobacterium Tuberculosis Co-Infection.Nature Reviews Microbiology. 2017; 16: 80-90.

Carroll KC, Butel J, Morse S, Mietzner T. Jawetz, Melnick, Adelberges Medical Microbiology. Edisi ke 27. New York: Mc Graw Hill Education; 2016.

Amin Z, Bahar A. Tuberkulosis Paru. Dalam: Buku Ajar Ilmu Penyakit Dalam. Edisi ke 4. Jakarta: Interna Publishing; 2014. hlm. 863-872.

Cliff JM, Kaufmann Stefan, McShane Helden P Van, Garra AO. The HumanImmune Response to Tuberculosis and ItsTreatment : A View From The Bloo2015;264:88-102.

Vaillant AA, Gulick PG. HIV Disease Current Practice. InStatPearls [Internet] 2020 Dec 30. StatPearls Publishing.

Rottenberg ME, Pawlowski A, Jansson M, Sko M. Tuberculosis and HIV Co-Infection. PLoS One. 2012;8(2):1-7.

WHO. Global Tuberculosis Report 2017. Switzerland: World Health Organization; 2017.

Dafitri IA, Medison I, Mizarti D. Laporan Kasus TB Paru Koinfeksi HIV/AIDS. Jurnal Kedokteran YARSI. 2020 Aug 13;28(2):021-31.

US Department of Health and Human Services. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. 2021



How to Cite

Ramadhan, H. G. ., & Togihon , L. . (2023). Miliary Pulmonary TB with Oral Thrush et causa HIV; Case Report. Medical Profession Journal of Lampung, 13(3), 277-285.