Focused assessment with sonography for HIV-associated tuberculosis (FASH) case series from a Rwandan district hospital

Introduction: The majority of HIV-TB co-infection worldwide is reported in Africa. The risk of developing extra-pulmonary tuberculosis (EPTB) increases as immune deficiency progresses but is difficult to diagnose. Point-of-care ultrasonography (POCUS) can be an effective adjunct to identify and treat EPTB-associated findings using the focused assessment with sonography for HIV-associated TB (FASH) protocol. Case report: Three HIV-infected patients without known history of EPTB presented to a Rwandan district hospital with fever and unclear infection. Initial testing did not reveal a source. Each patient was then evaluated with the FASH protocol by a Rwandan emergency physician with POCUS training. All patients had findings suggestive of EPTB by ultrasound. Anti-TB treatment was initiated, and all subsequently demonstrated symptom improvement. Discussion: This case series demonstrates the additional clinical information obtained. It describes how management was changed using POCUS and the FASH in a resource-limited setting in Rwanda and calls for further FASH protocol validation studies.