Fatal Isoniazid-Resistant Tuberculosis with Hepatic and Multiorgan Involvement in an HIV-Positive Patient

A fatal case of multiorgan isoniazid-resistant tuberculosis (TB) involving the liver, lungs, urinary tract, intestine, and central nervous system is presented in a 38-year-old male with advanced human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). The patient presented with systemic symptoms including fever, dyspnea, and right upper quadrant discomfort. Isoniazid resistance was confirmed using GeneXpert and Xpert MTB/XDR assays across multiple specimens. Despite targeted anti-tuberculosis therapy and initiation of antiretroviral treatment, the patient developed respiratory failure and a tension pneumothorax, resulting in death seven weeks after admission. This case highlights the diagnostic and therapeutic challenges of disseminated drug-resistant TB in severely immunocompromised individuals. The rare hepatic involvement emphasizes the importance of considering extrapulmonary manifestations in HIV-associated TB. Early molecular diagnostics, prompt initiation of therapy, and vigilant monitoring for complications are critical to improving outcomes. Clinician awareness of such complex presentations is essential, particularly in regions with a high prevalence of drug-resistant TB.