Fatal co-infection by multiple pathogens in an indigenous woman with miliary tuberculosis

Tuberculosis (TB), one of the leading causes of death worldwide, has a higher incidence among indigenous people. Miliary TB, an extrapulmonary form of TB, can cause multiple complications including autoimmune hemolytic anemia (AIHA) and secondary infections. Here we present a case of an indigenous woman from Colombia with miliary TB who presented with AIHA. Despite multiple treatments, therapies and medical interventions, the patient died after a severe medullary aplasia of multiple causes, including secondary myelotoxicity by immunosuppressive therapy and secondary disseminated infections by multiple pathogens, which together led to significant clinical complications. Co-infection with Staphylococcus aureus, Enterococcus faecium, Klebsiella pneumoniae and Candida glabrata, which were identified as drug-resistant microorganisms, further hindered treatment. This report highlights the great challenges of dealing with co-infections by resistant pathogens and aims to spur governments and public health authorities to focus attention in the prevention and management of TB, especially among vulnerable communities.