The COVID-19 pandemic has strained the healthcare system worldwide, leading to an approach favoring judicious resource allocation. A focus on resource preservation can result in anchoring bias and missed concurrent diagnosis. Coinfection of Mycobacterium tuberculosis (TB) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has implications beyond morbidity at the individual level and can lead to unintended TB exposure to others. We present six cases of COVID-19 with newly diagnosed cavitating pulmonary tuberculosis to highlight the significance of this phenomenon and favorable outcomes if recognized early.

Patient: Male, 28-year-old Final Diagnosis: COVID-19 • tuberculosis Symptoms: Dizziness • headache • vomiting Medication:— Clinical Procedure: Craniectomy Specialty: Infectious Diseases • Neurology • Pathology Objective: Rare co-existance of disease or pathology 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.

A 28-year-old woman without any history of prior antituberculosis treatment presented with cervical lymphadenopathy and a cold abscess near medial end of clavicle of 5 months duration. Pus culture and sensitivity revealed Mycobacterium tuberculosis resistant to rifampicin and isoniazid. Thus she was diagnosed as a case of primary multidrug-resistant tuberculosis and treated with second line drugs according to culture susceptibility pattern. On completion of therapy, patent showed good clinical response. This case highlights the observation that even extra-pulmonary primary multidrug-resistant tuberculosis can be successfully treated with currently available second line drugs.

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Infection due to Nocardia is reported mainly in immunocompromised patients. It usually presents as a pulmonary or disseminated disease with a predilection for the brain. Infections are a rare etiology of intracranial vascular aneurysms. Herein we report a case of disseminated Nocardia otitidiscaviarum ( N . otitidiscaviarum ) in a young female newly diagnosed with systemic lupus erythematosus (SLE) complicated by the development of an infectious intracranial aneurysm. To the best of our knowledge this is the fourth case of nocardial infection-related intracranial aneurysm and the second case of N. otitidiscaviarum infection to be reported in a patient with systemic lupus erythematosus. Features of previously reported N. otitidiscaviarum related intracranial aneurysm are reviewed.

Despite the widespread of coronavirus disease-19 (CO­VID-19) infection around the world, there are very scarce reported literature about the care of patients with a known diagnosis of hemoglobin disorders such as sickle cell disease (SCD) or thalassemia and confirmed COVID-19 infection. Thalassemia International Federation issued a position statement to include patients with thalassemia and SCD among the high-risk groups of patients. Here, we present an interesting case of a 42-year-old patient know to have SCD presenting with Vaso-occlusive (VOC) pain episode in the absence of COVID-19 signs and symptoms, who tested positive for COVID-19 infection and had a smooth recovery. This case highlights the importance of screening SCD patients presenting with VOC-related events even in the absence of COVID-19 signs and symptoms.

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