TYPE: Late Breaking Case Report
TOPIC: Chest Infections
INTRODUCTION: This is a case of concurrent pulmonary infections with mycobacterial tuberculosis, coccidioidomycosis, and SARS-COV-2 in an otherwise immunocompetent host.
CASE PRESENTATION: A 62-year-old male with no known medical history presented with three weeks history of worsening non-productive cough, dyspnea and pleuritic chest pain with associated small volume hemoptysis, twelve-pound weight loss, intermittent fevers and night sweats. The patient’s vital signs were normal except for a temperature of 38.2C. Physical exam showed a well-nourished man with no abnormal findings. Initial labs were significant for pancytopenia, a positive COVID PCR nasopharyngeal swab, and negative HIV. Chest x-ray showed bilateral opacities and a subsequent computed tomography angiogram of chest showed bilateral multiple thick-walled cavitating lung lesions in the upper lobes and bilateral scattered ground glass opacities suggestive of COVID pneumonia. Further work-up resulted in induced sputum showing acid fast bacilli which speciated Mycobacterium tuberculosis 3 weeks later. Serology revealed positive IgM antibodies to Coccidioides by quantitative immunodiffusion and negative IgG by complement fixation. Cocci-Direct PCR was negative twice. Fungal culture from induced sputum grew Paecilomyces formosus.
DISCUSSION: The patient likely had both these conditions and more recently acquired SARS-COV-2. There is no literature regarding a triple infection but, an excellent case series was done by Cadena et al that looked at 44 cases of PTB/Coccidioidomycosis co-infection. They found a significantly higher mortality rate compared to monoinfection. Such a coinfection in a patient with severe COVID-19 could become potentially devastating.
CONCLUSIONS: Treatment was initiated with rifampin, isoniazid, pyrazinamide, ethambutol, and fluconazole. He was discharged in good health.
DISCLOSURE: Nothing to declare.
KEYWORD: Coccidioidomycosis