Case #14: 79-year-old Thai male, with pulmonary hypertension, chronic obstructive pulmonary disease, and chronic kidney disease stage 3, had fever, rhinorrhoea, and cough for 3 days as the initial symptoms of COVID-19. He had no history of previous MTB infection. Chest radiograph showed massive pleural effusion in both lungs, which made the attending physician suspect pulmonary TB infection. The imaging was shown in the Fig. 2. RT-PCR for MTB complex was subsequently done and respectively detected. After 2-day of oral favipiravir oxygen desaturation was progressed, so he was given intravenous remdesivir for 8 days later. High dose dexamethasone was also administered intravenously for 5 days. On fourth day of dexamethasone, his oxygenation became worse, with lowest at 81% saturation. He complained of shortness of breath, so he received step-up oxygen supplementation by oxygen cannular, and then high flow nasal cannula. He also developed sharp chest pain which cardiac rubbing sound. Chest computed tomography (CT) showed bilateral pleural thickening with pleural effusion. Needle thoracocentesis was proceeded which later showed positive for AFB staining of pleural effusion suggesting TB pleurisy. Dexamethasone was tapered to oral prednisolone with total 23-day duration. His TB was treated with 2HRZE and 4HR continuum. He was markedly improved since a couple week of TB treatment and now his CXR returned to previous background with resolved effusion. Unfortunately, he died 3 months after the treatment was completed due to congestive heart failure.
Case #23: Thai male, aged 60 years, with end stage renal disease, hypertension, triple vessels disease, and type II diabetes mellitus, was admitted to our hospital due to COVID-19 RT-PCR detection two days after symptoms of cough, low grade fever, and mild dyspnoea. His CXR revealed perihilar infiltration in both lungs. He had no previous history of MTB infection also. Oral Favipiravir was administrated. He did not need corticosteroid because of mild COVID-19. On the fourth day of admission, the physician noticed the palpable mass at right supraclavicular area. Fine needle aspiration was done at the lesion, then AFB and PCR for MTB complex both detected. The imaging was shown in the Fig. 3 . Sputum RT-PCR for MTB complex was detected also. His disseminated TB treatment consisted of 2HRZE and 4HR regimen. The patient was discharged after 14 days of admission with clinical improvement and no adverse drug reaction found.