Clinical spectrum of COVID-19 in patients with underlying rheumatic disease -data from Pakistan

Introduction: Co-infection with tuberculosis during the SARS-COV2 pandemic has been described, but there is no description of these cases in systemic lupus erythematosus (SLE) patients. To our knowledge, here we present the first reported case of tuberculosis and COVID-19 coinfection in a patient with SLE. Presentation: We report a 57-year-old woman treated for pulmonary tuberculosis in 1996. The same year, the patient developed SLE with class IV lupus nephritis, arthritis, serositis, alopecia, and oral ulcers;she received high prednisolone doses and cyclophosphamide as induction therapy. Since then, she has been on prednisolone in descending doses up to 5 mg/d and mofetil mycophenolate in doses of 2 g/d. She was admitted to the hospital because of 14 days of general malaise, fever, and dyspnea. A CT scan of the chest was performed, finding peripheral ground-glass infiltrates, consolidation, and a cavitated nodule in the right upper lobe (Fig 1). A PCR for SARS-COV2 was positive and supportive treatment was started. She underwent bronchoalveolar lavage with positive acid-fast stain and PCR for Mycobacterium tuberculosis, which showed rifampicin sensitivity. She started treatment with rifampicin, isoniazid, pyrazinamide, and ethambutol. Discussion: During the SARS-COV2 pandemic, co-infection with tuberculosis has been described. Tadolini et al. (1) found that 28.3% of the patients with concomitance of this two diseases had a history of previously tuberculosis infection. It is not known if it is reinfection or reactivation of tuberculosis, however, these patients are usually older, have more comorbidities, and a higher percentage of mortality compared to patients in whom tuberculosis is diagnosed at the time or after COVID-19 diagnosis. It has been described that tuberculosis can facilitate the onset of viral infections, however, the relationship with SARS-COV2 is not fully established. TB patients are more likely to make severe clinical presentations of COVID-19 (2). To our knowledge, this is the first reported case of tuberculosis and COVID-19 coinfection in a patient with SLE.