A 96-year-old woman was admitted to our hospital complaining of cough, fever, and dyspnea which was started from 5 days ago, and it got worse within last 3 days. She was a known case of hypertension and dyslipidemia. Physical examination revealed an axillary temperature of 38 centigrade and a diffuse crackle in lung auscultation. Ear, nose, and throat examinations were normal, and no exudates or erythema were observed. Laboratory investigations indicated a lymphocytopenia, with the absolute count of 900 (30%) lymphocytes, and 1900 (65%) neutrophils. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also elevated and reported to be 119 and + 3, respectively. Arterial blood gas (ABG) assessment were normal (PH: 7.38, PCO2: 45, and HCO3: 26), and the SpO2 level were 84%. High-resolution computed tomography (HRCT) of lungs revealed typical characteristics of COVID-19 and a suspected TB cavity. Furthermore, a purified protein derivative (PPD) test was conducted, and after 72 h, the induration around the injection point was 25 mm. Then, sputum smear and culture study were performed for the patient, and they were both positive for tuberculosis. Also, the COVID-19 RT-PCR test was found to be positive.
Patient treatment was started with CPAP:5 and FiO2: 40%, and the SpO2 was increased to 93%. The hydroxychloroquine was begun for the patient twice a day with the first day dose of 800 mg and then 400 mg per day. Also, 1 g of ceftazidime was given to the patient three times a day. The atorvastatin and the aspirin ordered daily, 20 mg, and 80 mg respectively. Tuberculosis treatment was also added for the patient after the diagnosis (daily dose of isoniazid 300 mg, rifampicin 600 mg, ethambutol 1200 mg, and pyrazinamide 1500 mg for four month, followed by 2 months of isoniazid 300 mg, and rifampicin 600 mg). After 10 days, the patient's general condition got better. White blood cell (WBC) and lymphocyte count increased relatively to 4700 and 1600. The patient was free of dyspnea, fever, and a mild cough, and the SpO2 rate was 94% without any additional help. After discontinuing hydroxychloroquine, the patient was released to be home for further quarantine. During the follow-up for 3 weeks, the patient was completely free of any signs and symptoms.