On May 19, 2022, a retired black African woman in her 59s was admitted to the hospital with tuberculosis.Muscle soreness, a loss of weight of roughly 12 kg during the previous month, headaches, and a cough were the main symptoms of the admitted female. She had recently lost weight, had nocturnal sweats, and had a history of shortness of breath. Although she had no family medical history, they did have prior medical and pharmaceutical histories. She had no recent travel history and was COVID-19-infected. Five days prior to her admission, her sons, who worked in the medical field, were found to be infected with the COVID-19 infection. She has a history of drinking or using cigarettes going back 20 years. One year prior, she had pulmonary tuberculosis in her past. She had a history of receiving first-line anti-tuberculosis medication, which included four months of continuous phase treatment with rifampicin 150 mg and isoniazid 75 mg after two months of intensive phase treatment with rifampicin 150 mg, isoniazid 75 mg, pyrazinamide 400 mg, and ethambutol 275 mg. She had adhered strictly to her antitubercular therapy regimen. She arrived at the emergency room with stable hemodynamics.
The patient arrived at the emergency room with weak muscles, a fever, a productive cough, a sore throat, a lack of appetite, a headache, night sweats, and shortness of breath that had lasted for a day. Seven days before being admitted, she was in good health. Her vital signs upon entering the emergency room were as follows: 38.5°C body temperature, 52.8 kg body weight, 1.72 m height, 17.9 kg/m2 body mass index, 113/76 mmHg blood pressure, 19 cycles per minute respiratory rate, 112 beats per minute peripheral pulse, and 88% oxygen saturation in ambient air.
Upon admission to the emergency department, her blood chemistry showed a blood urea nitrogen of 46 mg/dl, serum creatinine 2.3 mg/dl, serum sodium 151 mEq/L, leukocytes 4,620/L, platelets 139,200/L, neutrophils 65%, hemoglobin 15.1 g/dL, an aspartate aminotransferase level of 68 units/L (normal value: 0–30 units/L), an alanine aminotransferase level of 95 units/L (normal value: 0–35 units/L), an erythrocyte sedimentation rate of 9 mm/hour (normal value: 0–20 mm/hr), lymphocytes 26%, and serum potassium 5.1 mEq/L. An arterial blood gas test showed a potential hydrogen of 7.37, a partial pressure of carbon dioxide of 29, a partial pressure of oxygen of 71, and a bicarbonate of 18. She received 4 liters of intranasal oxygen per minute via a nasal cannula until she was moved to the respiratory isolation room.
On arrival, a chest radiograph revealed a pleural empyema, a significant right upper lobe cavity, right middle lobe opacity, and right hilar fullness. He had no discomfort, rebound tenderness, or visible lymph nodes upon abdominal examination, but did have a bloated, tight abdomen with fluctuating dullness. On chest auscultation, there were reduced breath sounds in the right middle and upper lungs. Her Glasgow coma scale was 10/15 after assessment. With a heart rate of 112 beats per minute, his electrocardiogram revealed anterior-lateral ST depression and sinus tachycardia. A Mycobacterium tuberculosis infection without rifampicin resistance was detected in a sputum sample using the GeneXpert Mycobacterium tuberculosis and rifampicin tests. According to a tuberculosis culture, Mycobacterium tuberculosis was responsive to first-line anti-tuberculosis medications.
She has never before had a proven COVID-19 infection. She was tested for COVID-19 using two nasopharyngeal swabs in the emergency room one day after being hospitalized, and because the results were positive, she was transferred to the intensive care unit. The patient was admitted to an intensive care unit with a diagnosis of previously well-controlled pulmonary TB and a recently confirmed COVID-19 infection after spending two days in the emergency room.
To control the COVID-19 infection, the patient was moved to a respiratory isolation unit. The patient required continuous oxygen at a rate of four liters per minute via a nasal cannula for the first five days while in the hospital, and she is still taking her anti-tubercular medications.
She started receiving 1000 ml of fluid resuscitation (0.9% normal saline) and insulin by drip as soon as she was admitted to a respiratory isolation unit. As part of the protocol for managing SARS-CoV-2, she continued to breathe in oxygen at a rate of 4 liters per minute using a nasal cannula. She received subcutaneous enoxaparin 80 mg 12 hours a day to treat her proven COVID-19 infection. To treat her COVID-19 infection-related fever, she was given 500 mg of acetaminophen as required. After five days, enoxaparin was changed to low molecular weight heparin at a dosage of 1 mg/kg daily as a prophylactic for prothrombotic events. In order to combat hospital-acquired infections, she was given therapy with broad-spectrum antibiotics consisting of 500 mg of azithromycin given once a day for five days and 1 g of intravenous ceftriaxone administered daily for five days. The patient was stable on the sixth day and did not need oxygen treatment. She maintained her treatment for tuberculosis, which consisted of a two-month intensive phase including rifampicin 150 mg, isoniazid 75 mg, pyrazinamide 400 mg, and ethambutol 275 mg, and a four-month continuous phase involving rifampicin 150 mg and isoniazid 75 mg.
Patient perspective
The patient remained clinically stable after 15 days in the hospital and was released on June 4, 2022, after the results of two consecutive negative throat swab tests for COVID-19 infection. The patient was sent home with a follow-up visit at the tuberculosis clinic after two consecutive negative sputum acid-fast bacilli smear results. She was advised to continue monthly follow-up at the tuberculosis clinic.