Tuberculosis (extrapulmonary and latent) Quiz: Ace Your Exams

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A 52-year-old woman presents to the emergency department due to worsening fever and night sweats over several days. The patient has also had worsening back pain and unintentional weight loss of 22 lbs. (10 kg) over the past few months. Past medical history is significant for untreated HIV. She does not use tobacco, alcohol or recreational drugs. She frequently travels to South Asia to visit family. Temperature is 38.9 ºC (102.0 ºF),  pulse is 96/min, blood pressure is 145/89 mmHg, respiratory rate is 18/min, and SpO2 is 99% on room air. On physical examination, the patient appears cachectic and ill, but she is in no acute distress. Cardiac exam is within normal limits. Lung sounds are clear to auscultation. There is point tenderness over several lumbar spinous processes. There is decreased sensation in both lower extremities. A chest radiograph shows no abnormalities. MRI of the thoracic and lumbar spine shows destruction of the L2-L3 vertebral bodies and intervertebral discs. Interferon-gamma release assay is positive. Which of the following is the most appropriate next step in management?  

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