Respiratory Worsening at the End of a Hospital Stay for Severe Covid19 Pneumonia Revealing Pulmonary Tuberculosis

The coexistence of a viral and tuberculous respiratory infection increases mortality and the transition to a severe form in both directions. We report an observation for a 55-year-old woman with untreated diffuse interstitial pnuemopathy, investigated by immunological and infectious tests, and found negative for pulmonary tuberculosis. Bronchial biopsies revealed non-specific inflammation, responsible for chronic dyspnea. Having presented ten days previously with myalgias, fatigue, dry cough and fever, with worsening of basic dyspnoea, without digestive or neurological manifestations, she was referred to the emergency department, where physical examination showed SpO2 at 80% on room air, reduced to 92% under 15 L/mn delivered via a high-concentration mask, polypnoea at 40 cycles per minute with bilateral diffuse crackling rales on auscultation, scattering just the anterior quadrants. The initial evolution was favorable, with clinical improvement in oxygen saturation to 94% on two liters per minute of oxygen delivered by nasal cannula, with respiratory rate at 23 cycles per minute with modest effort tolerance. On day 18 of hospitalization, she presented with a febrile peak of 38.3°C, polypnoea at 33 cycles per minute, increased oxygen requirements with a flow rate of 6l/m by face mask to reach an oxygen saturation of 92%, tachycardia at 130 beats per minute, and was therefore readmitted to intensive care with high-flow nasal oxygen therapy and antibiotic therapy with imipenem and amikacin. Multiplex PCR showing no germ, and a PCR test for pulmonary tuberculosis on a sputum sample which was positive, prompting the introduction of antibacillary treatment based on a fixed quadric-association of rifampicin, isoniaside, pyrazinaamide and ethombutol. Non-specific antibiotic therapy was discontinued after improvement of the inflammatory syndrome, and antibacillary treatment is still ongoing. Conclusion: Through this observation we discuss the difficulties in terms of diagnosis, management and outcome of a coinfection by SARS-COV 19 and mycobacterium tuberculosis.