Five-Site Disseminated Rifampicin-Resistant Tuberculosis with Marasmic Severe Acute Malnutrition in a 14-Year-Old Girl: An Eighteen-Month Longitudinal Observation in Which the Nutritional and Psychosocial Instruments Did Not Agree

Abstract

Background: Adolescent rifampicin-resistant tuberculosis is usually reported through microbiological and treatment-outcome endpoints, while nutritional and psychosocial recovery is described mainly in narrative terms.

Objective: To describe the 18-month course of five-site disseminated rifampicin-resistant tuberculosis with marasmic severe acute malnutrition and assess agreement among nutritional and psychosocial recovery instruments.

Methods: This CARE-guided longitudinal case report followed a 14-year-old Indonesian girl using serial clinical, laboratory, anthropometric, imaging, and psychosocial assessments during an all-oral bedaquiline-based regimen with nutritional support.

Results: Tuberculosis involved the lung, ovary, peritoneum, sacrum, and temporal bone. Weight increased from 31 to 45 kg, body-mass-index-for-age z score from −3.27 to −0.68, haemoglobin from 10.1 to 13.5 g/dL after a nadir of 8.7 g/dL, and quality of life from 61.25 to 85.75. Nutritional indices were irreconcilable at the same visit, and two behavioural screens remained normal despite a psychiatric diagnosis and impaired quality of life.

Conclusion: Microbiological, nutritional, and psychosocial recovery did not proceed synchronously, and instruments within the same domain could disagree. The absent mid-point height prevented temporal ordering of recovery; a ten-item minimum longitudinal data set is proposed.