COVID-19 and pulmonary tuberculosis - A diagnostic dilemma

Abstract

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Meanwhile, pulmonary tuberculosis(TB) is one of the most common infective lung diseases in developing nations. The concurrence of pulmonary TB and COVID-19 can lead to poor prognosis, owing to the pre-existing lung damage caused by TB. Case presentation: We describe the imaging findings in 3 cases of COVID-19 pneumonia with co-existing pulmonary TB on HRCT thorax. The concurrence of COVID-19 and pulmonary TB can be a diagnostic dilemma. Correct diagnosis and prompt management is imperative to reduce mortality and morbidity. Hence it is pertinent for imaging departments to identify and report these distinct entities when presenting in conjunction.

Keywords: AFB, Acid-fast bacilli; CO-RADS, COVID-19 Reporting and Data System; COVID -19; COVID-19, Coronavirus disease 2019; CRP, C-reactive protein; CT, Computed tomography; Case report; Co-infection; DNA, Deoxyribonucleic acid; DOTS, Directly Observed Therapy, Short-Course; GGOs, Ground glass opacities; Ground glass opacities; HRCT; HRCT, High resolution computed tomography; ICU, Intensive care unit; RT-PCR, Reverse transcriptase-polymerase chain reaction; SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2; TB, Tuberculosis; Tuberculosis; WBC, White blood cell.

Fig. 1

A-D: Axial HRCT thorax showing (A) Peripheral subpleural GGOs (black arrows) with superimposed septal thickening (“crazy paving pattern”) in lower lobes of bilateral lung parenchyma. (B) Cavitatory lesion (red arrow) in right upper lobe with associated fibrotic changes and superimposed ground glass opacities in bilateral upper lobes. (C) Cylindrical bronchiectasis involving right upper lobe (white arrow) with peripheral subpleural GGO in left upper lobe and superior segment of right lower lobe. (D) Centrilobular nodules with “tree-in-bud” appearance in right upper lobe (white arrow) (Color version of figure is available online).

Fig. 2

A-D: (A) Axial HRCT thorax shows rounded subpleural GGOs in left upper lobe (white arrow). (B) Sagittal HRCT thorax of the left lung shows multifocal GGOs. (C) Axial HRCT thorax shows multiple tiny nodular opacities in right upper lobe (white arrow). (D) Sagittal HRCT thorax of the right lung shows tiny nodular opacities in upper lobe and patchy GGOs in lower lobe.

Fig. 3

A-D: (A) Axial HRCT thorax showing tiny nodular opacities with associated patchy consolidation in apical segment of right upper lobe. (B) Sagittal HRCT thorax of the right lung showing bronchiectatic changes in upper lobe (white arrow) with associated nodules and patchy consolidation. (C) Axial HRCT thorax showing tiny nodules scattered in bilateral lung parenchyma. (D) Axial HRCT thorax showing ill-defined GGOs in bilateral lower lobes (red arrows) (Color version of figure is available online).