A 67-year-old black African house wife with an HIV/AIDS diagnosis arrived at the emergency room on September 28, 2022. The admitted woman had significant complaints included muscle weakness, a loss of weight about 33 pounds during the preceding week, headache, and a cough. She had lately lost weight, experienced nighttime sweats, and had previously experienced breathlessness. There is no medical or pharmaceutical history in the family. She had no recent travel history. Her sons, who worked as laborers, were found to be infected with COVID-19 five days before her admission. She has never used smoking or drank alcohol. She has a history of medications and medical conditions. She had AIDS in her last twelve years. She had previously had TDF + 3TC + EFV as part of her first-line ART regimen. She had followed her ART program exactly. She had stable hemodynamics when she entered the emergency room.
The patient experienced a fever, nonproductive cough, sore throat, lack of appetite, headache, night sweats, and shortness of breath that had persisted for a day when they went to the emergency room. She arrived at the emergency room with the following vital signs: body temperature of 39.1°C; weight of 49.7 kg; height of 1.76 m; body mass index of 16 kg/m2, blood pressure of 113/76 mmHg; respiratory rate of 19 cycles per minute; peripheral pulse rate of 112 beats per minute; and oxygen saturation in the surrounding air of 88%.
Upon admission to the emergency department, her blood chemistry showed blood urea nitrogen of 46 mg/dl, serum creatinine of 2.3 mg/dl, leukocytes of 4,620/L, reduced white blood cell count without lymphopenia, hemoglobin of 15.1 g/dL, lymphocytes of 26%, and CD4 cell count was of 185cells/mm3. Until she was transferred to a critical care unit, she was given 4 liters of intranasal oxygen per minute via a nasal cannula.
Reduced breath sounds were audible on chest auscultation in the right middle and upper lungs. His electrocardiogram showed sinus tachycardia and anterior-lateral lead ST-depression. Using the GeneXpert mycobacterium tuberculosis and rifampicin assays, a Mycobacterium TB infection without rifampicin resistance was discovered in a sputum sample. Mycobacterium tuberculosis responded to first-line anti-TB drugs, according to a tuberculosis culture.
She has never had a confirmed COVID-19 infection previously. She had two nasopharyngeal swabs for COVID-19 testing, which were positive. Then, she was sent to the critical care unit. The patient was identified as having recently confirmed COVID-19 infection, newly acquired pulmonary TB, and previously well-controlled HIV/AIDS after spending two days in the emergency room. The patient was sent to a critical care unit in order to manage the COVID-19 infection and pulmonary tuberculosis. For the first five days of her stay in the hospital, the patient needed continuous oxygen delivered through a nasal cannula at a rate of four liters per minute, and she is still taking her ART regimen.
Immediately after being brought to a critical care unit, she began receiving 1000 ml of fluid resuscitation (0.9% normal saline) and insulin via drip. She carried on breathing oxygen through a nasal cannula at a rate of 4 liters per minute. She was treated for her confirmed COVID-19 infection with 40 mg of subcutaneous enoxaparin given every 12 hours. She received 500 mg of acetaminophen to treat her COVID-19 infection-related fever. She received low molecular weight heparin at a dose of 1 mg/kg daily for preventative measure against prothrombotic events. She received broad-spectrum antibiotic treatment consisting of 500 mg of azithromycin given once daily for five days and 1 g of intravenous ceftriaxone given every day for five days to treat hospital acquired infections. For TB treatment, she took rifampicin 150 mg, isoniazid 75 mg, pyrazinamide 400 mg, and ethambutol 275 mg during a two-month intensive phase of her TB therapy, then rifampicin 150 mg and isoniazid 75 mg for a four-month continuous phase. On the seven day, the patient was stable and did not require oxygen therapy. She kept using TDF + 3TC + EFV as part of her first-line ART protocol. She had followed her ART routine.
Patient Perspective
When two consecutive throat swab tests for COVID-19 infection came back negative, the patient was discharged on June 4, 2022, after spent 16 days in the hospital and remaining clinically stable. After receiving two consecutive negative sputum acid-fast bacilli smear findings. Her monthly follow-up appointments at the ART center should continue, she was told.