Challenging differential diagnosis, Rare co-existance of disease or pathology
José Arturo Martínez Orozco, Ángel Sánchez Tinajero, Eduardo Becerril Vargas, Andrea Iraís Delgado Cueva, Héctor Reséndiz Escobar, Eduardo Vázquez Alcocer, Luis Armando Narváez Díaz, Danna Patricia Ruiz Santillán
Laboratory of Clinical Microbiology, National Institute of Respiratory Diseases (INER), Mexico City, Mexico
Am J Case Rep 2020; 21:e927628
Available online: 2020-09-25
Coinfection with severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2) and Mycobacterium tuberculosis (MBT) has been reported, albeit rarely, in various parts of the world and has received attention from health systems because up to one-third of the world’s population has been infected with SARS-CoV-2. Mexico was not included in the first-ever report on a global cohort of patients with this coinfection. We report on a case of SARS-CoV-2/MBT coinfection in a 51-year-old taxi driver from Mexico City that underscores the importance of rapid and accurate laboratory testing, diagnosis, and treatment.
CASE REPORT: We present the case of a man in the sixth decade of life who was admitted to the National Institute of Respiratory Diseases (INER) with a diagnosis of COVID-19 pneumonia, which was confirmed by nasopharyngeal exudate using real-time polymerase chain reaction (RT-PCR) for the identification of SARS-CoV-2. Findings from imaging studies suggested that the patient might be coinfected with MBT. That suspicion was confirmed with light microscopy of a sputum sample after Ziehl-Neelsen staining and when a Cepheid Xpert MTB/RIF assay, an automated semi-quantitative RT-PCR assay, failed to detect rifampicin resistance. The patient was discharged from the hospital 10 days later.
CONCLUSIONS: The present report underscores the importance of using validated molecular diagnostic tests to identify coinfections in areas where there is a high prevalence of other causes of pneumonia, such as MBT, as a way to improve clinical outcomes in patients during the COVID-19 pandemic. While it is imperative to control the COVID-19 pandemic, the medical community must not forget about the other pandemics to which populations are still prey, and tuberculosis is one of them. We must remain alert to any clinical subtleties so as to ensure timely and accurate diagnosis and stay one step ahead of COVID-19.
Keywords: coinfection, COVID-19, Mycobacterium tuberculosis, Coronavirus Infections, severe acute respiratory syndrome, SARS Virus, Real-Time Polymerase Chain Reaction