Case Report: Development of Miliary Pulmonary Tuberculosis in a Patient with Peritoneal Tuberculosis after COVID-19 Upper Respiratory Tract Infection

Elziny, Moustafa M; Ghazy, Ahmed; Elfert, Khaled; Aboukamar, Mohamed

doi:10.4269/ajtmh.20-1156

Cited by 13 publications

(9 citation statements)

References 22 publications

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“…Most researchers regard pulmonary tuberculosis as a risk factor for the severe course of a new coronavirus infection ( Chen et al, 2020 ; Gupta et al, 2020 ; Khayat et al, 2021 ). The reverse negative interaction of these diseases has also been described – for example, an increased risk of a latent infection turning into an active form of tuberculosis against the background of COVID-19, due to the depletion of CD4 + T cells ( Elziny et al, 2021 ; Starshinova et al, 2021; Visca et al, 2021 ). Several studies have noted an aggravation of the course of both diseases in their mutual existence due to common social, epidemiological, and clinical determinants ( Mousquer et al, 2021 ; Ritacco and Kantor, 2020 ; Yang and Lu, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics of COVID-19 in patients with tuberculosis and factors associated with the disease severity

Parolina¹,

Pshenichnaya²,

Vasilyeva³

et al. 2022

International Journal of Infectious Diseases

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Section: Introductionmentioning

confidence: 99%

Clinical characteristics of COVID-19 in patients with tuberculosis and factors associated with the disease severity

Parolina¹,

Pshenichnaya²,

Vasilyeva³

et al. 2022

International Journal of Infectious Diseases

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“…[14] Stochino et al reported 20 patients with TB and COVID-19 coinfection, of which 3 patients were diagnosed with extrapulmonary TB. [15] Mustafa et al identified the development of miliary TB in a patient with peritoneal TB after COVID-19 infection, [16] and Yao et al described 2 cases of active pulmonary TB infection from latent pulmonary TB infection. [17] However, to the best of our knowledge, all cases reported have been adults, and reports describing a flare-up of TB infection following COVID-19 exposure, in the paediatric age group, have not been reported.…”

Section: Discussionmentioning

confidence: 99%

A case report on disseminated tuberculosis in the setting of coronavirus disease 2019: cause or consequence?

Khataniar¹,

Sunil²,

AV³

2022

Emerg Crit Care Med

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Tuberculosis (TB) is a deadly infection that can lead to disseminated disease in children <15years of age exhibiting risk factors such as low host immunity, concurrent infection(s), and/or malnutrition. A case involving a 14-year-old boy diagnosed with disseminated tuberculosis is reported. On investigation, the patient was positive for coronavirus disease 2019 (COVID-19) antibodies, GeneXpert (Cepheid, Sunnyvale, CA) positive for TB with multisystem involvement, lymphopenia, and highly elevated inflammatory markers, indicating multisystem inflammatory syndrome in children (MIS-C) and disseminated TB. The patient was started on antitubercular treatment (ATT), steroids, and supportive treatment. His condition improved over the ensuing few days, and he was discharged with ATT and antiepileptics. Although a few studies involving adults have established a connection between the progression of TB and COVID-19, this case report establishes a similar clinical picture in a child, which has not yet been reported.

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“…Outro fator determinante à evolução do quadro descrito pode ser atribuído à infecção prévia de CO-VID-19 nos três meses que antecederam sua internação hospitalar pela tuberculose miliar. Estudos recentes observaram que a infecção pelo vírus SARS-CoV-2 pode levar à uma disfunção imunológica, através da depleção de células T e diminuição na sua funcionalidade, facilitando um estado de imunossupressão e servindo, também, como uma ferramenta facilitadora à reativação de tuberculose (18) .…”

Section: Discussionunclassified

Tuberculose miliar como reação adversa grave ao uso do adalimumab na doença de Crohn: um relato de caso / Miliary tuberculosis as a severe adverse reaction to the use of adalimumab in Crohn's disease: a case report

Lopes

Vallandro

Scarpati

et al. 2021

Arq Med Hosp Fac Cienc Med Santa Casa São Paulo

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Introdução: A doença de Crohn é uma doença inflamatória intestinal (DII) que inicia um processo inflamatório crônico idiopático intestinal, levando a um quadro clínico variávelcujo principal sintoma é a diarreia crônica. O diagnóstico é feito a partir da combinação de dados clínicos, laboratoriais e exames endoscópicos. Após confirmado o diagnóstico, otratamento pode envolver classes medicamentosas como imunobiológicos. Em relação ao uso de imunobiológicos, como o adalimumabe, deve-se ter cautela pelo seu efeitoimunossupressor, que pode, em indivíduos susceptíveis, ativar focos latentes de infecção, como os de tuberculose (TB). Objetivo: Relatar um caso de tuberculose miliar como reação adversa ao uso de adalimumabe e conscientizar a comunidade médica quanto aos riscos da administração de terapia imunobiológica. Relato de caso: Paciente do sexo masculino, 31 anos, com diagnóstico de Doença de Crohn em acompanhamento ambulatorial com terapia imunobiológica com adalimumab, é admitido na emergência com quadro agudo de sintomas respiratórios e sistêmicos. Durante a investigação hospitalar, apesar de pesquisa do bacilo álcool- -ácido resistente (BAAR) no escarro ter apresentado três amostras negativas, a tomografia computadorizada (TC) de tórax apresentava padrão sugestivo de tuberculose miliar, além de um lavado broncoalveolar com pesquisa positiva para Mycobacterium tuberculosis. Confirmado o diagnóstico de TB miliar, o tratamento foi iniciado com rifampicina, isoniazida, pirazinamida e etambutol. Conclusão: Levando em consideração a alta mortalidade e os impactos negativos da tuberculose miliar, é imprescindível que todos os pacientes com DII em uso de imunobiológicos sejam rastreados para infecção latente, através da radiografia de tórax e teste tuberculínico (PPD). Entretanto, mesmo com o rastreio regular e registro de vacinação prévia, a possibilidade de tuberculose miliar ainda não pode ser descartada em quadros clínicos inespecíficos neste perfil de pacientes.Palavras chave: Adalimumab, Tuberculose, Efeitos colaterais e reações adversas relacionados a medicamentosABSTRACTIntroduction: Crohn’s disease is an inflammatory bowel disease (IBD) that initiates a chronic idiopathic intestinal inflammatory process, leading to a variety of clinical symptoms with chronic diarrhea as the main one. Diagnosis is built from a combination of clinical, laboratory and endoscopic data. The treatment involves immunobiological drugs, such as adalimumab and due to its immunosuppressive effect, it must be administered with caution, because it isable to activate latent foci of infection, such as tuberculosis (TB), in susceptible individuals. Objective: To report a miliary tuberculosis case originated as an adverse reaction to the use of adalimumab and to make the medical community aware of the risks of administering immunobiological therapy. Case report: A 31-year-old male, diagnosed with Crohn’s Disease, undergoing immunobiological treatment with adalimumab, is admitted in the emergency department with acute respiratory and systemic symptoms. During hospitalization, despite the investigation of alcohol-acid resistant bacillus (BAAR) in sputum showing three different samples with negative results, the computerized tomography (CT) of the chest showed a pattern suggestive of miliary tuberculosis, in addition to a bronchoalveolar lavage with a positive test for Mycobacterium tuberculosis. After the diagnosis of miliary TB was confirmed, treatment with rifampicin, isoniazid, pyrazinamide and ethambutol was started. Conclusion: Considering the high mortality and negative impacts of miliary tuberculosis, it is essentialthat all patients with IBD on immunobiological treatment are screened for latent infection through chest radiograph and PPD. However, even with regular screening and registration of previous vaccinations, the possibility of miliary tuberculosis cannot be ruled out in this profile of patients with unspecific clinical conditions.Keywords: Adalimumab, Tuberculosis, Drug-related side effects and adverse reactions

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Case Report: Development of Miliary Pulmonary Tuberculosis in a Patient with Peritoneal Tuberculosis after COVID-19 Upper Respiratory Tract Infection

Cited by 13 publications

References 22 publications

Clinical characteristics of COVID-19 in patients with tuberculosis and factors associated with the disease severity

Clinical characteristics of COVID-19 in patients with tuberculosis and factors associated with the disease severity

A case report on disseminated tuberculosis in the setting of coronavirus disease 2019: cause or consequence?

Tuberculose miliar como reação adversa grave ao uso do adalimumab na doença de Crohn: um relato de caso / Miliary tuberculosis as a severe adverse reaction to the use of adalimumab in Crohn's disease: a case report

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