Successful matched unrelated donor hematopoietic stem cell transplantation for infantile Wolman disease

Introduction: Wolman disease is a rare genetic disorder with an autosomal recessive inheritance. A mutation in the LIPA gene causes lysosomal acid lipase (LAL) deficiency results in lipid storage and adrenal insufficiency. Death in early infancy is due to liver failure. Patients and methods: We describe the clinical course of a three-month-old infant diagnosed with Wolman disease. A rapid mutational analysis confirmed a LIPA gene defect. Results: He underwent matched unrelated donor peripheral blood stem cell hematopoietic stem cell transplantation (HSCT) at 3 months of age, with a treosulfan-based conditioning, which resulted in engraftment with donor-derived hematopoietic cells. He required supportive care for sinusoidal obstruction syndrome and mucositis. He was administered low dose prednisolone for grade I skin graft versus host disease, and a complete donor chimerism was documented on several occasions. At one year post HSCT, his growth and development were optimal, and there was no hepatosplenomegaly. He is maintained on glucocorticoid and mineralocorticoid supplements for primary hypoaldosteronism. Conclusion: The case emphasizes the timely diagnosis and the potential for successful treatment of Wolman disease by HSCT. © 2022 Pediatric Hematology Oncology Chapter of Indian Academy of Pediatrics

An unusually fulminant case of encephalomyelitis in an 80 year old

Background: There have been reports of demyelinating syndromes in association with COVID-19 and to a much lesser extent COVID 19 vaccines. The association between demyelination and vaccines, in general, remains controversial. We review a presentation of fulminant demyelination, and discuss antecedent COVID-19 vaccination, the formulation of a broader differential diagnosis and ultimately the pathologic diagnosis. Case presentation: An 80-year-old woman presented with seizure, encephalopathy, quadriparesis and ultimately expired. She received a SARS-CoV-2 vaccine one day prior. Imaging revealed contrast enhancing cerebral lesions, longitudinally extensive transverse myelitis. CSF was markedly inflammatory. Pathologic examination of the CNS lesions revealed demyelination and inflammation beyond white matter, not restricted to a perivenular distribution. Conclusion(s): This case depicts a seemingly fulminant course of a diffuse demyelinating syndrome characterized clinicopathologically as Marburg's variant of multiple sclerosis. There are several unique aspects of this case including the extremely rapid course, the unusual evolution of CSF abnormalities, with hypoglycorrhachia and markedly elevated protein. The proximity to vaccination is a pertinent association to document, though we cannot unequivocally prove causation.Copyright © 2022 The Authors

Reactivation of Tuberculosis and COVID-19 in Pediatric Patients

Objective Mycobacterium tuberculosis is an immobile aerobic bacillus that causes tuberculosis (TB) disease. We aimed to evaluate the association between coronavirus disease 2019 (COVID-19), COVID-19-related drugs, TB reactivation, and TB incidence during the pandemic. Methods Eight patients who were diagnosed as having TB in Meram Medical Faculty, Necmettin Erbakan University between March 1, 2020, and December 31, 2021, at the beginning of the pandemic, were enrolled in this study. The presence of COVID-19 infection was confirmed using COVID-19 antibody tests and the patients' COVID-19 history. We evaluated the demographic data, laboratory findings, imaging tests, and pathology results of all patients. Results We checked all our patients with TB using COVID-19 antibodies (immunoglobulin [Ig]G + IgM) or polymerase chain reaction. Seven of the eight patients were female (87.5%). The median age was 16 years. Family screening of all patients was negative, and they had bacillus Calmette-Guerin vaccine scars. Two patients had chronic diseases. One was diagnosed as having primary ciliary dyskinesia in our department (patient no. 8) and the second was under follow-up by the rheumatology department with a diagnosis of juvenile idiopathic rheumatoid arthritis. Conclusion There has been an increase in the incidence of TB in children, especially in adolescents, during the pandemic period. This may be due to the pathogenic structure of the COVID-19 virus with an unknown mechanism. In addition, lifestyle changes and changes in health care policies during the pandemic may have caused this. Further research should be performed on this topic.Copyright © 2023 Authors. All rights reserved.

Genetic diversity of Mycobacterium tuberculosis isolates from northwest of Iran during COVID-19 era

Background: Tuberculosis (TB) is considered one of the most infectious diseases in the world. In this study, we intended to examine the epidemiology of tuberculosis by MIRU-VNTR to define the changes that occur in the transmission of tuberculosis in the region during the COVID-19 era. A total of 120 Mycobacterium tuberculosis isolates were collected from sputum samples of patients referred to East Azerbaijan Center TB from December 2020 to August 2021. Demographic information such as age, sex, place of birth, previous TB history, and relevant medical data was collected. The proportion method was performed for drug susceptibility testing, and the PCR-based MIRU-VNTR method was applied to identify molecular epidemiology relationships. Result(s): The isolates were collected from 78 male (65%) and 39 female (32.5%) Iranian patients and 3 (2.5%) Azerbaijani patients. Ninety-three distinct patterns were identified including 15 clustered patterns and 36 unique patterns. The largest cluster was composed of seven isolates. Furthermore, one cluster with 5 members, four clusters with 3 members, and nine clusters with 2 members. In MIRU-VNTR typing, 75 clusters belonged to the Tabriz region and just 3 to the Republic of Azerbaijan. All isolates were sensitive to rifampin, isoniazid, and ethambutol. Conclusion(s): Results of the current study showed COVID-19 pandemic had a direct effect on the transmission and diagnosis of tuberculosis. Less diagnosis and less clustering can indicate public controls and hygiene, and the use of masks had a direct effect on the transmission and diagnosis of tuberculosis. However, misidentification and less focus on other respiratory infections are expected during the pandemic. Studies on the co-infection of COVID-19 and tuberculosis and the role of mask and sanitization against TB are strongly recommended. Copyright © 2023, The Author(s).

Genetic diversity of Mycobacterium tuberculosis isolates from northwest of Iran during COVID-19 era

BackgroundTuberculosis (TB) is considered one of the most infectious diseases in the world. In this study, we intended to examine the epidemiology of tuberculosis by MIRU-VNTR to define the changes that occur in the transmission of tuberculosis in the region during the COVID-19 era. A total of 120 Mycobacterium tuberculosis isolates were collected from sputum samples of patients referred to East Azerbaijan Center TB from December 2020 to August 2021. Demographic information such as age, sex, place of birth, previous TB history, and relevant medical data was collected. The proportion method was performed for drug susceptibility testing, and the PCR-based MIRU-VNTR method was applied to identify molecular epidemiology relationships.ResultsThe isolates were collected from 78 male (65%) and 39 female (32.5%) Iranian patients and 3 (2.5%) Azerbaijani patients. Ninety-three distinct patterns were identified including 15 clustered patterns and 36 unique patterns. The largest cluster was composed of seven isolates. Furthermore, one cluster with 5 members, four clusters with 3 members, and nine clusters with 2 members. In MIRU-VNTR typing, 75 clusters belonged to the Tabriz region and just 3 to the Republic of Azerbaijan. All isolates were sensitive to rifampin, isoniazid, and ethambutol.ConclusionsResults of the current study showed COVID-19 pandemic had a direct effect on the transmission and diagnosis of tuberculosis. Less diagnosis and less clustering can indicate public controls and hygiene, and the use of masks had a direct effect on the transmission and diagnosis of tuberculosis. However, misidentification and less focus on other respiratory infections are expected during the pandemic. Studies on the co-infection of COVID-19 and tuberculosis and the role of mask and sanitization against TB are strongly recommended.

TB DURING THE SEROCONVERSION PHASE

SESSION TITLE: TB and TB-Involved Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Patients who are HIV positive have a high risk of co-infection with tuberculosis (TB). Screening tests for HIV identify antibodies that are present during the seroconversion, or window phase. Here we present a case of reactivation TB during the seroconversion phase of HIV with an initially negative QuantiFERON test. CASE PRESENTATION: A previously healthy 24-year-old female presented with a productive cough. She was found to have leukopenia and apical consolidation on chest CT and was treated for community-acquired pneumonia with mild improvement of symptoms. Her QuantiFERON, COVID-19, and HIV antibody screen were negative;however, her reflex HIV antigen was positive. She re-presented a month later with a worsening cough, drenching night sweats, weight loss, vomiting, and dysphonia. Her chest CT noted a right apical cavitary lesion and bilateral upper lobe micronodules with endobronchial spreading. Her QuantiFERON and HIV antibody were now both positive. She was started on rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) therapy and on raltegravir and emtricitabine/tenofovir. DISCUSSION: Above we describe a case of reactivation TB during the seroconversion phase of HIV with a negative QuantiFERON. Primary TB presents in the middle lobes without signs of structural damage whereas secondary TB typically involves the apices and presents with cavitation. Secondary TB is typically due to reactivation or reinfection in immunosuppressed patients. Although we believe this case is due to reactivation due to radiographic findings, her initial QuantiFERON was negative. However, studies have shown that QuantiFERON may have uncertain results in latent TB infections in patients with underlying HIV (1). Reliable testing for latent TB in HIV-positive individuals is necessary as HIV increases the risk of developing active TB and TB increases the risk of transitioning from HIV to AIDS (2). CONCLUSIONS: TB is one of the top 10 causes of death worldwide and HIV is a common coinfection. To the best of our knowledge, this is the first published report of reactivation TB during the seroconversion phase of HIV with an initially negative QuantiFERON. Overall, more research must be done to identify the risk of infections during the seroconversion phase and physicians must be able to identify radiographic findings concerning for TB in patients with underlying HIV. Reference #1: Elisa Petruccioli, Teresa Chiacchio, Elisa Petruccioli, et al. Effect of HIV-infection on QuantiFERON-plus accuracy in patients with active tuberculosis and latent infection, Journal of Infection, 2020;80(5): 536-546. https://doi.org/10.1016/j.jinf.2020.02.009. Reference #2: Bruchfeld, Judith et al. "Tuberculosis and HIV Coinfection.” Cold Spring Harbor perspectives in medicine vol. 5,7 a017871. 26 Feb. 2015, doi:10.1101/cshperspect.a017871 Reference #3: Johnson JL, Okwera A, Hom DL, et al. Duration of efficacy of treatment of latent tuberculosis infection in HIV-infected adults. AIDS. 2001;15(16):2137-2147. doi:10.1097/00002030-200111090-00009 World Health Organization. Tuberculosis [Internet]. 2021 [cited 2022 Mar. 15];Available from: https://www.who.int/news-room/fact-sheets/detail/tuberculosis DISCLOSURES: No relevant relationships by Loor Alshawa No relevant relationships by Angela Binkowski No relevant relationships by Sara Qutubuddin

MISSED TB DIAGNOSIS DURING THE COVID-19 PANDEMIC: MYTH OR REAL

SESSION TITLE: COVID-19 Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Miliary Tuberculosis (TB) is a rare disorder caused by the hematogenous dissemination of Mycobacterium tuberculosis. Patients infected with Mycobacterium tuberculosis can develop Miliary TB from primary infection or reactivation of a latent infection. Many patients with Miliary TB will present with symptoms of classic tuberculosis and in the pandemic time overlaps with symptoms of Covid-19. Since the Covid-19 pandemic the reported TB diagnosis fell 20% in 2020 and remained 13% lower in 2021 as compared to pre-COVID-19 pandemic. Decrease in cases may be due to pandemic-related mitigation efforts, such as social distancing and wearing masks. CASE PRESENTATION: This patient is a 23-year-old undocumented male who presented to the ED, originally in January of 2021, with complaints of generally not feeling well. He reported feeling feverish and having a poor appetite for the past 2 weeks. At this visit, the patient received testing for COVID-19, Influenza and strep;all of which were negative. He was then discharged home and instructed to follow-up outpatient. In July of 2021, the patient again presented to the ED with complaints of weakness, fevers, cough, and weight loss that have progressively worsened. A chest x-ray and CT chest were performed at this time which were positive for innumerable bilateral upper lobe predominant peri-bronchial vascular nodular airspace opacities and patchy areas of consolidation with central cavitation, highly suspicious for tuberculosis. A QuantiFERON gold test was ordered and the patient underwent bronchoscopy. After 2 weeks of hospitalization, a NAAT test came back positive for Tuberculosis. At this point, the patient was immediately started on rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE). The patient received 2 weeks of RIPE treatment and after being hospitalized for 1 month, he was then discharged home on RIPE therapy with strict instructions to follow-up outpatient. DISCUSSION: Similarities in symptoms of TB and COVID-19 may mean that some people who have TB are being evaluated for COVID-19, but not tested for TB. The case was very unusual in that the infection of TB went undiagnosed during his initial emergency department (ED) during the Pandemic surges. It had not been discovered until presenting to the ED 5 months later with worsening symptoms. In presenting this case, we hope to further education on Miliary TB and prevent future missed diagnoses given the extremely infectious nature of the disease. CONCLUSIONS: The 2020 and 2021 declines may be related to factors associated with the COVID-19 pandemic like similarities in symptoms between COVID-19 and TB disease may have led to missed TB diagnoses;widespread disruptions to healthcare during the COVID-19 pandemic may have delayed TB diagnoses;and Efforts to prevent COVID-19, such as wearing masks and staying six feet away from others, may also reduce the spread of TB. Reference #1: Masahiro Narita, Grace Hatt, Katelynne Gardner Toren, Kim Vuong, Monica Pecha, John A Jereb, Neela D Goswami, Delayed Tuberculosis Diagnoses During the Coronavirus Disease 2019 (COVID-19) Pandemic in 2020—King County, Washington, Clinical Infectious Diseases, Volume 73, Issue Supplement_1, 15 July 2021, Pages S74–S76, https://doi.org/10.1093/cid/ciab387 Reference #2: Cleverley J, Piper J, Jones MM. The role of chest radiography in confirming COVID-19 pneumonia. BMJ 2020;370 : m2426. Reference #3: https://www.cdc.gov/media/releases/2022/s0324-tuberculosis-covid-19.html DISCLOSURES: No relevant relationships by Nawal Aamir No relevant relationships by Gabrielle Gerbino

REACTIVATION MILIARY TB IN THE SETTING OF POSTINFECTIOUS COVID-19 LUNGS

SESSION TITLE: Pathologies of the Post-COVID-19 World SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION: Tuberculosis, caused from infection by M. tuberculosis, affects 2.7 per 100,000 people in the United States. 1 Miliary, or disseminated, TB is a progressive disease characterized by lymphohematogenous dissemination of TB infection that occurs in only 1-2% of TB cases. Little research has gone into pulmonary complications post recovery from COVID-19 infection, especially reactivation of latent TB. Here we present a case of reactivation of latent TB and progression to miliary TB in the setting of post COVID infection. CASE PRESENTATION: A 49-year-old male presented to the ER with fever, shortness of breath, and chest pain. His CXR showed diffuse bilateral, multifocal infiltrates and laboratory testing later came back positive for COVID-19. Two days later, he came back to the ED with acute respiratory failure with 87% oxygen saturation with ambulation. A CT chest done that showed diffuse lung disease consistent with COVID-19 infection, and a right upper lobe lesion likely a granuloma (image 1). He was treated for COVID pneumonia for ten days in the hospital with Decadron, Lasix, and tocilizumab. He required high flow nasal canula during the hospitalization and was discharged when his respiratory status had improved. One year later, he returns with few days of hemoptysis, fever, and chills. He had a progressive cough and 19 pound weight loss overt the last month. Clinically, he appeared mildly diaphoretic without acute distress. He had a room-air oxygen saturation of 95% without labored respiration and did not have increased oxygen demand. CT of the showed diffuse pulmonary parenchymal abnormalities and uniform nodular consolidative changes in the upper lobes bilaterally with areas of cavitation and multiple areas of lung parenchymal changes consistent with miliary TB (image 2). Sputum culture was positive for acid-fast bacilli, and he was started on RIPE therapy with rifampin, isoniazid, pyrazinamide, and ethambutol. He was symptomatically improved within one week of admission and was hospitalized until three negative sputum cultures were drawn. DISCUSSION: This case report gives us novel understanding of the extent of possible complications post recovery from COVID-19 infection. We have already started to see many patients who have recovered from an initial COVID infection, but progressed to secondary lung disease due to this. In our patient particularly, during his initial presentation he was seen to have upper lobe granulomatous disease with concern for latent TB. It is likely that due to the extent of damage done to his lung parenchyma over time it led to reactivation of his latent TB. As we see more patients recovering from COVID infections, we are likely to see more of similar cases of latent infection reactivation. CONCLUSIONS: Patients with latent TB are likely at a high risk of reactivation post recovering from COVID-19 infection, due to immunosuppression and lung parenchymal damage Reference #1: Trends 2019 ;Data & Statistics ;TB ;CDC. Cdc.gov. https://www.cdc.gov/tb/publications/factsheets/statistics/tbtrends.htm. Published 2021. Accessed September 25, 2021. Reference #2: Rodriquez-Morales AJ et al. Clinical, laboratory, and imaging features of COVID-19: a systemic review and meta-analysis. Travel Med Infect Dis. 34: 101623 Reference #3: Colditz GA, Brewer TF, Berkey CS, et al. Efficacy of BCG vaccine in the prevention of tuberculosis. Meta-analysis of the published literature. JAMA. 1994;271(9):698-702 DISCLOSURES: No relevant relationships by Sharmin Asha No relevant relationships by Heather Bernstein no disclosure on file for zachary brittingham;no disclosure on file for Vedee Ramdass;

NECROTIZING PNEUMONIA WITH HYDROPNEUMOTHORAX CAUSED BY MYCOBACTERIUM TUBERCULOSIS WITH IN A HEALTHY YOUNG WOMAN

CASE: Patient is a 21-year-old Guatemalan female with no significant past medical history was hospitalized with worsening productive cough for the last 4 weeks, with greenish sputum associated with pleuritic chest pain, shortness of breath and low appetite. Patient denies any fever, night sweating, weight loss. She states that she came from Guatemala around 3 years ago. Denies any nausea, vomiting, diarrhea, abdominal pain, falls or injuries. She works in the poultry industry. No sick contact. No recent travel. She denies any family members with similar symptoms. No reported history of TB in the family. On admission, she was alert, vitals were stable except for mild tachycardia, and was saturating well on room air. Physical examination revealed dullness on percussion, diffuse crackles, and decreasing breath sound bilaterally. Cell blood count with white blood cells 8.6G/L (72.4% neutrophil and 15% lymphocyte) and hemoglobin ad hematocrit 10.5/34.7 and mildly elevated liver transaminase level were recorded. Chest X-ray showed, Severe bilateral basilar pneumonitis worse on left. Moderate-sized left pleural effusion and the first contrast-enhanced chest computed tomography (CT)revealed severe multifocal necrotizing pneumonia with bilateral pleural effusions. The left pleural effusion raised the question of a loculated infected pleural effusion, and she also developed small apical hydropneumothorax. Patient was started on broadspectrum antibiotic coverage as well as pigtail placement on the left for drainage of pleural effusion. Fungal serologies, QuantiFERON gold assay, pleural fluid studies and sputum series for AFB stain were sent. COVID PCR negative. Cryptococcal negative. HIV negative. Sputum culture showing gram- negative rods Serratia marcescens and positive acid-fast bacilli for mycobacterium tuberculosis, pleural fluid is strongly exudative and sputum AFB smear showed positive PCR for Mycobacterium tuberculosis complex. She started on Rifampin, INH, Pyrazinamide and Ethambutol. IMPACT/DISCUSSION: Necrotizing pneumonia is a serious complication of community acquired Pneumonia, it's a rare but severe condition of lung parenchyma destruction commonly caused by bacterial pathogens. Necrotizing Pneumonia with M.tuberculosis have been reported in children and several cases of pulmonary gangrene in adults but very few cases of necrotizing pneumonia have been reported.The destruction of pulmonary parenchyma induced by M. tuberculosis usually develops from months to years but there are a few cases (necrotizing pneumonia and pulmonary gangrene) in which this destruction may progress rapidly causing severe respiratory failure. The pathogenic mechanism can be explained by the intensive tuberculous inflammation causing the widespread vascular thrombosis and arteritis. CONCLUSION: Our case report highlights the rarity of Mycobacterium tuberculosis causing necrotizing pneumonia and physicians should be aware of this rare presentation which develops rapidly causing severe respiratory failure.

The impact of the COVID-19 pandemic on the resistance level of Mycobacterium tuberculosis in suspected tuberculosis patients at the Surakarta Central General Hospital

Background:Analysis of the impact of the Covid-19 pandemic on the resistance level of Mycobacterium tuberculosis (MTb) isolates to Anti Tuberculosis Drugs (ATD) needs to be carried out considering the level of MTB resistance is an important factor in the occurrence of Multidrug-Resistant TB (MDR-TB) in Indonesia. The purpose of the study was to analyze the impact of the Covid-19 pandemic on the level of resistance of MTb isolates of patients with suspected TB in Surakarta. Subjects and Method: This research is a quantitative descriptive study with a retrospective Cohort based on the medical record data of suspected TB patients at Surakarta Central General Hospital in 2020 - 2021. The sampling technique was random sampling with a total of 200 samples each year. Data analysis used the SPSS 21 program.

SÍNDROME DE LEPIN-FROIN: RELATO DE UM CASO EM PACIENTE INTERNADO NUM SERVIÇO DE REFERÊNCIA DE HIV/AIDS NA CIDADE DE SÃO PAULO

A síndrome de Lepine-Froin (SLF) é a combinação de liquido cefalorraquidiano (LCR) xantocrômico e hiperproteico. O fenômeno foi descrito pela primeira vez em 1910 após uma punção lombar em um paciente com um tumor da medula espinhal. Acredita-se que a fisiopatologia seja devido a processos que afetam o fluxo normal do LCR que resulta em hiperproteinose e hipercoagulação. A prevalência da SLF ainda não foi relatada. Mulher, 43 anos, natural de Flores (Pernambuco), procurou serviço de referência em HIV-Aids de São Paulo por apresentar febre há 02 meses, disfagia, perda ponderal e confusão mental. Evoluiu com perda de força e vomito. Seu diagnóstico de HIV era conhecido há 11 anos, e abandou tratamento há 6 anos. No mês anterior tratou pneumocistose empiricamente devido quadro de dispneia (usou medicação 10 dias). Na admissão: paciente confusa, desorientada no tempo e espaço, com rigidez de nuca, tremores de extremidades, eupneica em ar ambiente. Seu LCR fortemente xantocrômico, com viscosidade aumentada, cujo resultado foi 126 leucócitos (86% linfocitos, 12% neutrofilos e 2% monócitos), proteínas 2.7 g e cultura para complexo M.tuberculosis positiva. Iniciado tratamento para Neurotuberculose com Rifampicina, Isoniazida, Pirazinamida e Etambutol e corticoide. Realizou Tomografia Computadorizada (TC) de Tórax com imagens de micronódulos difusos em parênquima pulmonar e vidro fosco periférico, predominante em bases, com algumas consolidações. Solicitada pesquisa para SARS-CoV-2, e transferência hospital de referência. No outro serviço, solicitados exames de imagem que mostraram abaulamento discais simétricos com compressão do saco dural, sem repercussão radicular. No crânio: imagem sugestiva de infarto lacunar associada a discreta dilatação do sistema ventricular, sem sinais de hipertensão. Avaliada pela Neurologia, descrito que o quadro típico de neurotuberculose, porém não afastaram Neurotoxoplasmose. Iniciado tratamento com Sulfametoxazol-Trimetropim. Retornou nosso serviço, sendo reavaliada pela Neurologia, agora de nosso serviço. Ao exame apresentou Kernig e Brudzinsky presentes, associado a paraparesia crural com força muscular grau III e redução de reflexos e da sensibilidade membros inferiores, Suspeitou-se de SLF, a qual foi posteriormente confirmada por Ressonância Coluna. Recebeu alta para acompanhamento no SAE próximo de sua residência.

TUBERCULOSE MIMETIZANDO IMPLANTES SECUNDÁRIOS EM PULMÃO

Introdução: Na tuberculose pulmonar (TBp), os principais padrões radiológicos são cavitação e nódulos centrolobulares com padrão de árvore em brotamento, predominantemente nos lobos superiores, e espessamento das paredes brônquicas. No entanto, podemos encontrar manifestações radiológicas atípicas como os tuberculomas pulmonares, tornando o diagnóstico, nestes casos, mais desafiador. Geralmente, o tuberculoma pulmonar aparece isolado e ocorre em cerca de 5% dos casos de tuberculose pulmonar. Nódulos múltiplos, que mimetizam neoplasia pulmonar ou metástases, por sua vez, são ainda mais incomuns. Descrição do caso: Trata-se de uma paciente do sexo feminino, 43 anos, hipertensa, asmática e com diagnóstico de espondiloartrite com início do quadro, do qual não soube precisar data, caracterizado por tosse seca diária e eventualmente com secreção branca ou hemoptise, que piora à noite e melhora parcialmente com anti-histamínico. Há cerca de 1 ano e meio, apresentou dor em dorso e precórdio, que piorava ao esforço físico e tosse, sem fatores de melhora. Há 10 meses, apresentou dispneia aos pequenos esforços, quando teve diagnóstico de COVID-19, porém os sintomas pulmonares se exacerbaram progressivamente. Relata também sudorese noturna e perda ponderal de 7 kg em 3 meses. Em março de 2021, realizou PET CT que evidenciou nódulos pulmonares múltiplos em lobos inferiores e superior direito, sem atividade metabólica específica e de etiologia a esclarecer. Foi realizada segmentectomia pulmonar à direita, no entanto a análise histopatológica da peça revelou processo inflamatório crônico e extensas áreas de necrose caseosa em segmento de lobo inferior direito, sugerindo diagnóstico de TBp, sendo encaminhada para nosso serviço especializado. Foi descartado o HIV. Após 4 meses de uso de rifampicina, isoniazida, pirazinamida e etambutol, 4 comprimidos por dia, paciente refere melhora da tosse seca e da sudorese noturna, além de melhora da adinamia e astenia. Comentários: Geralmente, nódulos pulmonares múltiplos são malignos, chegando a responder a 80% dos casos. No entanto, tuberculose pulmonar no Brasil e na região nordeste, deve sempre ser considerada como diagnóstico diferencial, mesmo diante de imagem não típica.

Tuberculosis

Tuberculosis (TB) is a communicable, airborne infectious disease caused by the bacterium Mycobacterium tuberculosis (MTB). A quarter of the world's population is infected with TB, affecting all age groups. Infection with MTB results in latent or active disease. Latent infection is associated with a 10% lifetime risk of developing active disease, but this is much higher in those with concurrent immunosuppression. Despite being both preventable and curable, TB remains the leading cause of global death from a single infectious agent. Active disease most commonly affects the lungs but can spread to cause extrapulmonary disease anywhere in the body. Over half of individuals in the UK now present with features of extrapulmonary TB, those with HIV being at particular risk. In all cases, obtaining samples for TB culture is absolutely vital. Standard treatment is with quadruple therapy for 6 months, extended in TB meningitis and often TB bone infection. Adjunctive corticosteroids have proven benefit in TB meningitis and TB pericarditis, and can be considered in other circumstances, such as paradoxical reactions to starting treatment in miliary TB. Despite recent gains in diagnosing and treating TB cases worldwide, the global COVID-19 pandemic is likely to have significantly affected recent progress.