21st June 2024

A patient is undergoing first-line treatment for tuberculous cervical adenitis simultaneously

A patient is undergoing first-line treatment for tuberculous cervical adenitis simultaneously while initiating antiretroviral therapy (abacavir 300 mg once daily, lamivudine 300 mg once daily, and raltegravir 800 mg twice daily) for a new diagnosis of advanced HIV. An aspirate of the affected node stains positive for Mycobacterium tuberculosis on auramine staining, and NAAT testing proves negative for mutations associated with rifampicin resistance. The sample is sent for culture and phenotypic sensitivities. After an initial improvement in the pain and size of the neck lesion, they re-present at week 5 of treatment with worsening swelling of the lesions, pain and pus-like discharge. They describe full adherence to their antiretroviral and anti-tuberculous therapy and are systemically well. Which of the following is the most appropriate action to be taken here?

Select the SINGLE most appropriate option from the list below. Select ONE option only.