Pulmonary tuberculosis and COVID-19 coinfection : Hickam’s Dictum revisited

Larry, Ellee Nyanti and Zhun, Han Wong and Benjamin Sachdev, Manjit Singh and Kean, Andrew Wei Chang and Ahmad Tirmizi, Jobli and Hock, Hin Chua (2022) Pulmonary tuberculosis and COVID-19 coinfection : Hickam’s Dictum revisited. Respiratory Medicine Case Reports, 37.

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Abstract

COVID-19 and pulmonary tuberculosis (PTB) coinfection is associated with increased mortality and presents a unique diagnostic challenge to the clinician. We describe three cases of newly diagnosed PTB in COVID-19 patients treated at our centre and their clinical and radiological features. The challenges associated with diagnosis and management are also explored. Patient 1 was a case of smear positive, endobronchial tuberculosis incidentally diagnosed due to CT changes, and eventually made good recovery. Patient 2 was a case of COVID-19 who succumbed but was diagnosed posthumously due to a positive sputum culture for tuberculosis. Patient 3 showed radiographic features of PTB and was treated empirically for TB. In conclusion, COVID-19 and PTB coinfection should be suspected in the presence of constitutional symptoms, prior immunocompromised states, prolonged respiratory symptoms or fever, or unresolved radiological abnormalities, more so in regions where TB is endemic. List of abbreviations TB tuberculosis PTB pulmonary tuberculosis CT computed tomography WHO World Health Organization NPOP nasopharyngeal and oropharyngeal CTPA computed tomography pulmonary angiogram HRCT high resolution computed tomography GGO ground glass opacities ATT anti-tuberculous therapy IGRA interferon-gamma release assay * Corresponding author. Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia. E-mail addresses: larrynyanti@ums.edu.my (L.E. Nyanti), zhunhan@hotmail.com (Z.H. Wong), benjaminsachdev@gmail.com (B. Sachdev Manjit Singh), andrchang@gmail.com (A.K.W. Chang), jatirmizi@unimas.my (A.T. Jobli), hhchua2009@gmail.com (H.H. Chua). Contents lists available at ScienceDirect Respiratory Medicine Case Reports journal homepage: www.elsevier.com/locate/rmcr https://doi.org/10.1016/j.rmcr.2022.101653 Received 5 February 2022; Received in revised form 12 March 2022; Accepted 13 April 2022

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