Dual Burden of MDR-TB and COVID-19 in a Previously Treated Tuberculosis Case: Diagnostic and Therapeutic Dilemmas

The presence of both MDR-TB and COVID-19 complicates diagnosis and treatment, as their symptoms can overlap, resulting in possible delays in receiving the appropriate care. This study aimed to investigate whether COVID-19 plays a role in the initiation or progression of latent or current tuberculosis (TB) infection, especially MDR-TB, through immunosuppression or lung injury. On May 19, 2022, a retired black African 40-year-old woman was admitted to the emergency room. She had a history of persistent cough, fever, muscle weakness, and weight loss. Reverse transcription polymerase chain reaction (RT-PCR) confirmed the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), indicating a positive COVID-19 diagnosis. GeneXpert MTB/RIF identified Mycobacterium tuberculosis (Mtb) and detected rifampicin resistance, confirming MDR-TB. An oral daily antituberculosis regimen consisting of 4 months of kanamycin 1220 mg, moxifloxacin 800 mg, prothionamide 750 mg, clofazimine 100 mg, pyrazinamide 1200 mg, high-dose isoniazid (HH) 600 mg, ethambutol 1200 mg, and for 5 months moxifloxacin 800 mg, clofazimine 100 mg, pyrazinamide 1200 mg, and ethambutol 1200 mg. She received ≈ 5000 IU of low-molecular-weight heparin (80 IU/kg for her 61 kg body weight) every 12 h to prevent prothrombotic episodes.