We report a rare case of a poly-infection (with COVID-19) with a very good course of the COVID-19 infection under chloroquine and rifampicin. The patient was a 32-year-old female, with no peculiar medical history, who presented to the ER with respiratory discomfort which had progressed for a month with influenza-like symptoms (feeling of fever, cough, headache, myalgia). She was feverish at 38.1 degrees celsius, had polypnea at 23 cycles per minute, normal heart rate at 80 beats per minute with an arterial pressure at 95/70 millimeters of mercury, her weight was 50 kilogram for a height of 1.60 meter. She had edema on her lower limbs and stage 1 gluteal ulcers. Upon suspecting COVID-19 infection in the patient, lab and imaging studies were carried out: A Polymerization Chain Reaction was positive for COVID-19 on a nasopharyngeal sample; A thoracic computed tomography (Figure 1) was able to identify multiple micronodules very likely related to a miliary tuberculosis. The bacteriological study of 3 sputum samples showed an infection with Koch s bacillus. Human immunodeficiency virus (HIV) serology was positive with a low CD4 T lymphocytes count of 32 elements/microliter. The patient had anemia with 7.6 gram/deciliter hemoglobin, thrombocytopenia of 70,000 elements/microliter, leucopenia of 2,880 elements/microliter, hyper-ferritinemia at 8,972 nanogram/milliliter.
The diagnosis of lung miliary tuberculosis with COVID-19 infection was evoked, in a setting of retroviral immunosuppression with HIV. The patient was put on anti-tubercular treatment at the daily dose adapted to her weight (isoniazid 5 milligram/kilogram/day, rifampin 10 milligram/kilogram/day, pyrazinamide 30 milligram/kilogram/day and ethambutol 25 milligram/kilogram/day). For the treatment of COVID-19, the patient was put on chloroquine (500 milligram x 2/day) for 10 days and azithromycin (500 milligram the first day then 250 milligram/day for 7 days). The progression was marked by the obtaining of two negative PCR controls at the end of treatment (on days 9 and 10), defervescence of the fever, reduction in respiratory discomfort and cough. Currently, after a follow-up of one and a half months, she continues to improve under anti-mycobacterial treatment, with a weight of 53 kilogram and good cicatrization of the gluteal ulcers.