An HIV-infected infant with Bacille Calmette-Guérin disease, recurrent and multidrug-resistant tuberculosis complicated by acute cor pulmonale and hepatitis while on antiretroviral therapy

We describe the management of an HIV-infected infant with multisystem disease. The infant presented with severe disease at 3 months of age. Initiation of antiretroviral therapy (ART) was delayed through initial lack of access, after which she developed immune reconstitution inflammatory syndrome to BCG. At this time she was also infected with Mycobacterium tuberculosis, with a later recurrence due to multidrug-resistant (MDR) tuberculosis (TB). During this episode she presented with acute cor pulmonale, possibly due to a pulmonary embolus and also transaminitis. Although such infants are seen frequently in sub-Saharan Africa, there are few guidelines or case descriptions to assist clinicians.