TUBERCULOSIS WITH COVID 19 IN A YOUNG WOMAN WITH ATYPICAL RADIOLOGICAL FINDINGS

Quantiferon test of the blood was positive but smear and RT-PCR of the sputum were negative. Blood examinations showed a neutrophil leucocytosis, hypochromic microcytic anaemia (haemoglobin 10.5 g %) .C-reactive protein and erythrocyte sedimentation rate were elevated (46.24 mg/dl and 113 mm/h, respectively). His renal and liver function tests were within normal range.Human immune deficiency virus (HIV) and Hepatitis B and C viral infections were excluded.


ISSN: 2320-5407
Int. J. Adv. Res. 8(07), 1184-1187 1185 Quantiferon test of the blood was positive but smear and RT-PCR of the sputum were negative. Blood examinations showed a neutrophil leucocytosis, hypochromic microcytic anaemia (haemoglobin 10.5 g %) .C-reactive protein and erythrocyte sedimentation rate were elevated (46.24 mg/dl and 113 mm/h, respectively). His renal and liver function tests were within normal range.Human immune deficiency virus (HIV) and Hepatitis B and C viral infections were excluded.
She was admitted to an isolation ward and was given specific treatment for both infections .
However, she developed severe shortness of breath 3 days after .Oxygen was administered to the patient. however the symptom did not improve and she was transferred to intensive care unit and started on non-invasive ventilation. While writing this article, this patient's situation deteriorated and she was intubated for mechanical ventilation.

Discussion:-
Many recent studies have described common chest imaging findings of lung pathology caused by SARS-COV2 (1) .
The most common Chest CT findings of COVID-19 are areas of consolidation and ground-glass opacity (GGO) with bilateral peripheral involvement in multiple lobes progressing to "crazy-paving" patterns and consolidation (2).
Pleural effusion, extensive tiny lung nodules, and lymphadenopathy occur in a very small number of cases and suggest bacterial superinfection or another diagnosis (4) .
The particularity of our case is the atypical presentation of an organized pneumonia associatied with mediastinale lymphadenopathy without any specific distribution of ground glass opacities.Moreover the co-infection covid 19 and tuberculosis is remarkable. Some Authors reported that the variation of radiological presentation is related to the timing of disease or to the co-infection with other infectious agents and that was the case in our patient ( 3).
Therefore,It is recommended that individuals with signs of pneumonia on chest CT be quarantined while RT-PCR testing is performed in conjunction with a thorough medical evaluation including travel history and disease contacts in order to make an accurate COVID-19 diagnosis as RT-PCR is the gold standard diagnostic method (2,9).
The co-infection of TB and COVID-19 is still being discussed, but there is the possibility both could exacerbate the natural symptoms of the other .
People ill with COVID-19 and TB show similar symptoms such as cough, fever and difficulty breathing. Accurate diagnostic tests are essential for both TB and COVID-19. Tests for the two conditions are different and both should be realized for individuals with respiratory symptoms ,especially In countries that have a high burden of TB (5),and that was the approach with our patient.
TB is technically deadlier than COVID-19, though we have to consider the diseases themselves and other risk factors: age, HIV status, the quality of the body's immune systems, etc ( 8).
People with active, untreated TB are far more likely to die than even the highest projected mortality estimates for COVID-19,wich explains the poor evolution of our patient. However, COVID-19 affects the lungs, and when associated to left-over damage of the lungs following TB disease such as traction bronchectasies may put an increased risk of developing more severe COVID-19 manifestations (8) .
While experience on COVID-19 infection in TB patients remains limited, it is anticipated that People ill with both TB and COVID-19 may have poorer treatment outcomes, especially if TB treatment is interrupted (5).
TB patients should take precautions as advised by health authorities to be protected from COVID-19 and continue their TB treatment as prescribed (5).

Conclusion:-
Atypical CT presentations of covid 19 can false the diagnosis and RT-PCR is still the recommended tool in diagnosing COVID-19.
Experience on joint management of both COVID-19 infection and TB remains limited As COVID-19 is so new.
There are no data currently on if those with or who have a previous history of TB are more at risk of worse outcomes.
Teaching point: 1. The variation of radiological presentation of COVID-19 is related to the timing of disease or to the coinfection. 2. Atypical CT presentation of covid 19 such as an organized pneumonia and/or lymphadenopathy may mislead the diagnosis. 3. The radiologists should know the key points of clinical manifestation, laboratory findings, and exposure history to diagnose the patients with suspected COVID-19 infection in clinical practice beyond radiologic findings.

Fig. 1:-
Chest -xray shows a pulmonary opacity in the lower left lobe(yellow arrow) with traction bronchectasis in the right upper lobe(Green arrow).
Unenhanced Axial CT images shows a large area of consolidation with central ground-glass opacities and focal crazy paving in the lower left lobe(Lobar pneumonia Corad 3)(Purple arrow).Air bronchogram can be seen inside consolidation(Red arrow).