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A 45 year old man with diabetes mellitus self presents to the TB clinic with productive cough for the past month. The sputum was yellow in colour, copious, and was streaked with blood twice. In that time, he has also hadcontinuousfevers around 38°C, not associated with rigors, and he has lost around 5 kg of weight in the past two months. He reports undergoing treatment for drug sensitive TB three years ago, although he did not take his treatment regularly and did not complete the 6 month course. He lives with his wife and two children, none of whom have had any major respiratory illnesses or have been diagnosed with TB. He works in a garment factory for daily wages, does not drink alcohol, and is a former smoker, having smoked 10 cigarettes per day for 20 years, and quitting three years ago. A cartridge based nucleic acid amplification test of his sputum detected Mycobacterium tuberculosis with rifampicin resistance.A sputum smear for acid fast bacilli showed 3+, and X ray imaging of the chest showed extensive parenchymal infiltrates in bilateral lung fields with cavitations.