Community-Acquired Pneumonia due to Streptococcus pneumoniae: When to Consider Coinfection with Active Pulmonary Tuberculosis

Community-acquired pneumonia (CAP) is an important cause of hospitalizations in adults. In the United States, Streptococcus pneumoniae is the most frequently identified bacterial pathogen responsible for CAP. Other etiologic pathogens of CAP vary based on the geographic region. Mycobacterium tuberculosis is an uncommon cause of CAP in the United States, while it is a principal cause in many African and Asian countries. Coinfection with Streptococcus pneumoniae and Mycobacterium tuberculosis is rare and has only been reported in the setting of underlying HIV infection in areas of high tuberculosis prevalence. Here, we report a case of CAP in the absence of HIV, where Streptococcus pneumoniae was identified on admission and delay in diagnosis of concomitant active pulmonary tuberculosis led to inappropriate isolation. In addition to a high index of suspicion, epidemiologic and radiographic findings can be helpful to recognize tuberculosis as a cause of CAP even when other pathogens have already been identified.