Septic Shock in the Course of Disseminated Tuberculosis in A COVID-19 Positive Patient with Concomitant AIDS

Abstract

A 23-year-old male patient presented to the Provincial Hospital for Infectious Diseases in Warsaw, Poland in February 2022 with severe septic shock in the course of COVID-19 infection. The patient’s history and physical exam indicated a suspicion of HIV, TB, and COVID-19 triple coinfection. Numerous ulcers and phlegmon were present on the lower limbs and back with the patient complaining of difficulty walking. Laboratory tests came back positive for COVID-19, saliva tests were positive for active tuberculosis, and blood test results for the CD4 count were < 200 cells/cubic millimeter confirming an AIDS diagnosis. Further testing and imaging revealed disseminated tuberculosis with involvement of bone in the left foot and thoracic spine, confirming Pott’s Disease. Treatment was started immediately for the septic shock with norepinephrine, vancomycin, meropenem, levofloxacin, and aggressive fluid resuscitation. COVID-19 treatment included oxygen mask therapy, systemic steroids and molnupiravir. Tuberculosis treatment was begun with isoniazid, rifampin, ethambutol, and pyrazinamide. Antiretroviral therapy (ART) was begun upon confirmed HIV/AIDS diagnosis using emtricitabine, tenofovir and dolutegravir. The patient was not previously on any ART and was not aware of his HIV/AIDS positive status.