PULMONARY COINFECTION BY MYCOBACTERIUM TUBERCULOSIS AND STAPHYLOCOCCUS AUREUS IN AN IMMUNOCOMPETENT PATIENT: A CASE REPORT

Mycobacterium tuberculosis (MTB) and community-acquired methicillin-resistant Staphylococcus aureus (MRSA) are pathogens capable of causing infections in different body sites. However, a literature search for the incidence of coinfection by both pathogens isolated in the same site revealed only one case report published to date. An 18-year-old male patient, resident of the metropolitan region of Porto Alegre, an active smoker but previously healthy, sustained burns to his palms at work, followed by desquamation. Days later, he developed pain, erythema, edema, and warmth on the dorsum of the left hand and forearm, sought urgent care, and was prescribed symptomatic medications. In the following week, he developed progressive dyspnea, cough with serosanguineous sputum, fever, and night sweats for 15 days. During this period, he lost 15 kg. After seeking care again, he was admitted to a local hospital. Ceftriaxone and doxycycline were started, without clinical improvement, and the regimen was changed to vancomycin, administered for 3 weeks. Chest CT showed multiple cavitary lesions in the periphery of the upper, middle, and left lower lobes, as well as hydropneumothorax and a right lung abscess. He was transferred to a tertiary hospital for thoracic surgery evaluation. On admission, he had marked cachexia, globally decreased breath sounds on auscultation, and dyspnea on minimal exertion, with persistent night sweats but no other respiratory complaints. Fiberoptic bronchoscopy was performed, with bronchoalveolar lavage, and percutaneous drainage of the abscess. MTB DNA testing on bronchoalveolar lavage was positive, with no rifampin resistance; the patient denied any prior TB treatment. Culture of drained pleural fluid identified community-acquired MRSA, thus establishing the diagnosis of coinfection. Once stabilized, the patient was discharged to complete standard tuberculosis treatment, with outpatient follow-up. In Brazil, tuberculosis remains endemic, requiring a high index of suspicion. However, co-infection with tuberculosis and community-acquired MRSA at the same site is uncommon and warrants attention and suspicion in light of the patient’s clinical presentation.