This question does not relate to my health. I am a PA working in West Africa. Two weeks ago, a 30yo HIV negative male began treatment with the usual combo of 4 drugs for BAAR positive and miliary TB.

However, since the treatment began 2 weeks ago, his condition has worsened. He is currently tachypnic, dyspnic and on oxygen.

The TB dept here decided to stop his tx, especially the rifampin, stating that this can cause sudden respiratory failure, however, my research has not corroborated this concern. In addition I found that rifampin resistance is usually rare, albeit in occidental countries where TB and HIV are not endemic.

The patient's CXR is quite dramatic, with homogenous (miliary) infiltrates dominating all lung fields.

So what do you think we are dealing with? Resistant organisms? Adverse effects of Rifampin? Or just a possibly fatal, greatly advanced case of TB?

I await your response. Thank you so much for your time,
Sarah MS PA-C