Concurrent COVID-19 and Tuberculosis in an Immigrant Worker Presenting with Hemoptysis

A 59-year-old man was referred to our hospital by a regional public health center for the treatment of coronavirus disease 2019 (COVID-19), which was diagnosed by the nasopharyngeal swab polymerase chain reaction test. The patient, who is immigrant worker from Nepal at an Indian restaurant in Japan, had acute-onset fever, productive cough with hemoptysis, and taste and smell disorders for 8 days before admission. He had no past medical history including tuberculosis (TB), and no subacute or chronic symptoms to suspect TB. None of his family members had TB. When he was admitted, he had a body temperature of 37.4 C, a respiratory rate of 14 breaths/min, an oxygen saturation level of 100%, and his chest radiograph showed clear lungs (Figure He used acetaminophen and dextromethorphan hydrobromide hydrate to control his fever and cough, but his body temperature proceeded to exceed 38 C for 5 days after hospitalization, his productive cough with hemoptysis worsened, and although his oxygen saturation level did not decline, he gradually lost his appetite. We therefore elected to examine his sputum at day 5 after admission. Initial acid-fast stain smears were negative for 3 consecutive days, but the patient finally tested positive for TB by our in-house laboratory polymerase chain reaction analysis of his sputum. Chest computed tomographic scans performed on day 8 after admission revealed bilateral ground-glass opacities, which are typical for COVID-19 patients, and a tree-in-bud pattern in the left upper lobe showing active TB (Figure There were no computed tomographic findings to suspect hilar and mediastinal lymphadenopathy.