Case 1
A 46 years old Iranian housewife with a history of chronic coughs since
two months ago presented with exacerbation of coughs together with
dyspnea. The patient had a history of liver cirrhosis secondary to
autoimmune hepatitis and it was being treated with UDCA, azathioprine,
spironolactone, and furosemide. The patient has a history of fever,
chills, myalgia, bone pain, and exposure to a symptomatic person. She
has been a smoker and has received two doses of the COVID-19 vaccine.
Vital signs were as follows: temperature of 36.5°C, heart rate of
75/min, blood pressure of 110/80mmHg, a respiratory rate 18 of breaths
per minute, and SPO2 of 95%.
In physical examination, the conjunctiva was pale and coarse crackle was
auscultated in both lungs. Based on the history and symptoms of the
patient, PCR tests for COVID-19 and influenza were taken which were
positive simultaneously. Patient treatment started with oseltamivir
75mili per-oral (po) every 12 hours and remdesivir 200mg STAT and 100mg
daily through IV-line. In spiral chest CT-Scan, there were multiple
patchy ground-glass opacities together with consolidations in both lung
fields some of them are cavitated especially in RUL more in favor of TB,
and LUL appearance is suggestive of superinfection of COVID-19 or
influenza viral pneumonia (Fig. 1). Acid-Fast Bacteria (AFB) test was
done for the patient which yielded a 3+ result. Based on tuberculosis
diagnosis, fixed-dose combination antituberculosis drug therapy with
three ‘tabs started.