COVID-19 promoting the development of active tuberculosis in a patient with latent tuberculosis infection: A case report

We report the case of a 40-year-old female diagnosed with COVID-19 after presenting to our institution with fever, cough and myalgia for three days. Her nasopharyngeal swab tested positive for SARS COV-2 by real time PCR and her plain chest radiograph was reported as normal. She did not require hospitalization and at telephone follow up she confirmed her illness lasted 11 days. Seven weeks later she presented with chest pain, dyspnea and fever for two days. Her repeat chest imaging showed right upper zone consolidation and this culminated in a microbiological diagnosis of pulmonary tuberculosis. The patient's daughter had been treated for tuberculosis two years earlier and unfortunately family screening for latent TB was not undertaken. This case appears to confirm the concerns that the CD4(+) T-cell depletion associated with COVID-19 may promote the development of active tuberculosis from latent infection much like HIV does. If this effect is widespread it may have a significant impact on the worldwide TB burden. We suggest vigilance to ensure patients are diagnosed early and meticulous contact tracing is undertaken to treat those with latent tuberculosis.