CONSPIRATORS: AN OLD RESPIRATORY PATHOGEN UNLEASHED BY A NEW ONE

Abstract

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: There is emerging, albeit still limited data, on the interaction between COVID-19 and tuberculosis (TB). Both infections can cause dysregulation of the immune system, suggesting a biological plausibility for one disease but also for COVID-19 infection leading to TB progression. A meta-analysis recently found an increased risk of severe COVID-19 disease in the setting of tuberculosis, although this wasn't statistically significant. The second suggested biological plausibility for tuberculosis worsening or predisposing to COVID-19 infection but concluded that not enough evidence exists to understand the relationship between tuberculosis and COVID-19. Since the relationship remains uncertain, special attention should be paid to how infections from COVID-19 and tuberculosis interact, especially in endemic areas. CASE PRESENTATION: We present a 21 year-old female who presented to the emergency department (ED) with a chief complaint of shortness of breath. She had no medical history besides recent diagnosis of COVID-19 four months prior to admission, which did not require hospitalization. Since then, she reported persistent cough, and suddenly presented with shortness of breath one day prior to admission and eventually prompted ED presentation. She had no other significant symptoms nor sick contacts. In the ED, she presented with a fever of 39.3 C, tachycardia, hypoxia and tachypnea. Computed Tomography of the chest revealed bilateral pulmonary consolidation and no evidence of pulmonary embolism. An extensive autoimmune and infectious workup was unrevealing. Despite broad-spectrum antibiotics, she progressed rapidly to multi-organ failure requiring mechanical ventilation, vasopressor support, and continuous renal replacement therapy, culminating in death. Autopsy revealed alveolar hyalinization with necrotizing granulomatous infection of bilateral lungs, pleura, and pericardium, positive for acid fast bacilli. Cause of death was acute respiratory distress syndrome (ARDS) secondary to pulmonary tuberculosis. DISCUSSION: In this report, we highlight a case of a young, immunocompetent patient with no underlying risk factors who died from multi-organ failure and ARDS secondary to pulmonary and possibly disseminated tuberculosis. We suspect that her recent COVID-19 infection may have allowed latent tuberculosis to reactivate and rapidly progress to severe disease, which ultimately led to multi-organ failure and death. CONCLUSIONS: This case highlights the need for further studies to be completed on the deleterious effects of even mild COVID-19 infections, and its ability to exacerbate other types of pulmonary infections. The significance between COVID-19 and tuberculosis should be evaluated further. REFERENCE #1: Gao Y, Liu M, Chen Y, Shi S, Geng J, Tian J. Association between tuberculosis and COVID-19 severity and mortality: A rapid systematic review and meta-analysis. J Med Virol. 2021;93(1):194-196. doi:10.1002/jmv.26311 REFERENCE #2: Visca D, Ong CWM, Tiberi S, et al. Tuberculosis and COVID-19 interaction: A review of biological, clinical and public health effects. Pulmonology. 2021;27(2):151-165. doi:10.1016/j.pulmoe.2020.12.012 DISCLOSURES: No relevant relationships by Stephanie Guo, source=Web Response No relevant relationships by Florence Kan, source=Web Response No relevant relationships by Stephanie Pyskir, source=Web Response No relevant relationships by Brent Tatsuno, source=Web Response