Triple infection with pulmonary tuberculosis, chronic hepatitis C and systemic brucellosis in an HIV/AIDS patient: a case report from northwestern China
Abstract
Background and objectives: Profound immune suppression in people living with HIV/AIDS predisposes to multiple opportunistic and endemic infections. While HIV/tuberculosis (TB) and HIV/hepatitis C virus (HCV) coinfections are well recognized, simultaneous infection with Mycobacterium tuberculosis, HCV, and Brucella spp. is exceptionally rare. Such triple infection poses substantial diagnostic and therapeutic challenges, especially in endemic settings where overlapping febrile syndromes may obscure multiple concurrent etiologies. We describe a complex case of HIV/TB/HCV/brucellosis coinfection from northwestern China and summarize the diagnostic approach, staged treatment strategy, and long-term outcome.
Case presentation: A 43-year-old man with a history of intravenous drug use and poorly controlled HIV infection presented with fatigue and progressive left scrotal swelling. He was found to have advanced HIV disease (CD4+ T-cell count 128/μL; HIV RNA 15,000 copies/mL), pulmonary TB confirmed by bronchoalveolar lavage fluid culture, chronic hepatitis C virus infection, and systemic brucellosis confirmed by blood culture and serology. Baseline liver biochemistry was within normal limits, although imaging suggested underlying chronic hepatic vulnerability. Initial treatment consisted of an individualized anti-tuberculosis regimen with isoniazid, rifampin, ethambutol, and levofloxacin, a 12-week rifampin-levofloxacin regimen for brucellosis, and ART with tenofovir disoproxil…
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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