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A 28-Year-Old Man from India with SARS-Cov-2 and Pulmonary Tuberculosis Co-Infection with Central Nervous System Involvement

Challenging differential diagnosis, Rare coexistence of disease or pathology

Fateen Ata, Qudsum Yousaf, Jessiya Veliyankodan Parambil, Jabeed Parengal, Mohamed G. Mohamedali, Zohaib Yousaf

Qatar Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar

Am J Case Rep 2020; 21:e926034

DOI: 10.12659/AJCR.926034

Available online: 2020-07-30

Published: 2020-08-19


#926034

BACKGROUND: Tuberculosis (TB) is a great mimic of central nervous system (CNS) tumors. This mimicry may pose a challenge, as the management of both diseases is quite different. Furthermore, the temporal association of initiating treatment affects prognosis. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mainly infects the pulmonary system. However, in a patient with concomitant pulmonary tuberculosis, it can be a diagnostic challenge.
CASE REPORT: A 28-year-old man of Indian origin presented with headache and vomiting. He had a brain mass on imaging suggestive of a glioma. He also had lung infiltrates and was diagnosed with a co-infection by SARS-CoV-2, by a reverse-transcription polymerase chain reaction (RT-PCR) using the GeneXpert system. The mass was excised and was found to be a tuberculoma, diagnosed by Xpert MTB. He received first-line anti-TB and treatment for COVID-19 pneumonia based on local guidelines.
CONCLUSIONS: This report highlights that COVID-19 can co-exist with other infectious diseases, such as TB. A high degree of clinical suspicion is required to detect TB with atypical presentation. A co-infection of pulmonary and CNS TB with COVID-19 can present a diagnostic challenge, and appropriate patient management relies on an accurate and rapid diagnosis. Surgery may be necessary if there are compressive signs and symptoms secondary to CNS TB. A diagnosis of COVID-19 should not delay urgent surgeries. Further studies are needed to understand the effects of COVID-19 on the clinical course of TB.

Keywords: Glioma, Mycobacterium Infections, Tuberculosis, Central Nervous System



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