a clinical case

Cohabitation of TB-AIDS-COVID-19: discussions on a clinical case

Daniela Robu Popa

University of Medicine and Pharmacy “Grigore T. Popa”, Iași (PhD student), Clinical Hospital of Pneumophtisiology, Iași

Oana Rohozneanu Melinte

University of Medicine and Pharmacy “Grigore T. Popa”, Iași (PhD student)

Ioana Buculei

University of Medicine and Pharmacy “Grigore T. Popa”, Iași (PhD student)

Raluca Dospinescu Arcana

University of Medicine and Pharmacy “Grigore T. Popa”, Iași (PhD student), Clinical Hospital of Pneumophtisiology, Iași

Antigona Trofor

University of Medicine and Pharmacy “Grigore T. Popa”, Iași, Clinical Hospital of Pneumophtisiology, Iași

Introduction: HIV/AIDS is an important risk factor in the development of pulmonary tuberculosis, an association that can have an unpredictable evolution and a high rate of complications, including SARS-CoV-2 infection.

Case description: A 32-year-old patient, with a confirmed diagnosis of STAGE C3 AIDS DISEASE from 2009, non-adherent and non-compliant with antiretroviral therapy (ARV), presents to the Clinical Hospital of Pneumophthisiology Iasi for cough with mucopurulent sputum, fever, weight loss (about 10 kg in the last 2 months) and loss of appetite, symptoms that started 2 months ago. At the clinical examination, the patient had an affected general condition, BMI= 21 kg/m2, generalized polyadenopathy (enlarged, mobile and painless cervical, submandibular and axillary ganglia), diminished vesicular murmur and disseminated bronchial rales bilaterally, temperature=37.8°C, SpO2=96% a.a., BP=115/80mmHg, abdomen sensitive to superficial and deep palpation of the right hypochondrium, liver located 2 cm below the costal rim, spleen located 1 cm below the left costal rim. The initial paraclinical evaluation revealed pancytopenia, HIV plasma viremia of 2.47 million copies/ml, Ly CD4=94 cells/mmc, RT-PCR test negative for SARS-CoV-2 infection,

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positive GeneXpert MTB/RIF test and chest CT scan detects multiple micronodules, approximately 1-2 mm scattered on both lung areas, which respect the bases, mediastinal, supraclavicular and axillary lymphadenopathy and left pleural fluid with a maximum thickness of 40 mm. ARV treatment, prophylaxis of Pneumocystis jirovecii pneumonia and tuberculostatic treatment were instituted. Subsequently, the patient's condition deteriorates, in dynamics was confirmed a positive RT-PCR test for SARS-CoV-2 infection, reason for which the therapeutic approach was modified, with a clinical, paraclinical and radiological evolution slowly favorable later.

Discussions and conclusions

The association of TB-AIDS with a value of LyCD4= 94cells/mmc is common and requires careful management and therapeutic strategies, given the fragility of these categories of immunocompromised patients who frequently develop forms of miliary pulmonary tuberculosis. Patient compliance with both tuberculostatic and antiretroviral therapy is essential to achieve the remission of symptoms and to avoid further sequelae.

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