Disseminated TB in the Setting of COVID-19 Infection- a Cause or a Consequence?

ABSTRACT

Introduction: Tuberculosis is a deadly infection, which can lead to disseminated TB in children in the presence of risk factors like low host immunity, concurrent infections, etc. This led us to wonder about the relationship between a common killer infection like TB and Coronavirus disease 2019 (COVID-19) and how the disease pattern will present in the pediatric age group. Case Description We report a case of a 14-year-old male child who was a known case of childhood TB meningitis and hydrocephalus;treated with VP shunt, who recently presented with disseminated TB/TB flare up, causing TB meningitis, TB peritonitis, and pulmonary TB. On investigation, the patient was positive for COVID antibodies, multisystem involvement, lymphopenia and highly raised inflammatory markers suggesting it to be a case of MIS-C induced TB dissemination. He was started on anti-tubercular treatment (ATT), steroids, and supportive treatment, while he never required intravenous immunoglobulin (IVIG). His condition subsequently improved over a few days and he was discharged on ATT and antiepileptics. Discussion: COVID-19 has been reported to be associated with other infections of the respiratory system. Few studies in adults have established a connection between the progression of TB following COVID-19 infection. The link between TB and COVID-19 is mostly bi-directional. The temporary immunosuppression caused by tuberculosis may lead to increased predisposition to COVID-19 infection, while COVID may, in turn, also increase susceptibility to TB infection due to substantial depletions in T-cell lymphocyte counts, promoting the development of active TB in patients with latent TB. Conclusion: In this case report, the child recovered only with corticosteroids and supportive care, with no requirement of immunoglobulins or intensive care after a few days and showing almost a complete recovery. This is an important point to be considered when exploratory therapy is considered for TB with MIS-C. Hence, a better understanding of the pathogenic mechanism of the disease may help in defining the appropriate interventions required for specific cases. USG abdomen showing moderate ascites with few thick internal septations (Red arrow) MRI Brain showing communicating hydrocephalus with dilated lateral and third ventricles (Red star) and an ill-defined area of non-diffusion restricting T2 FLAIR hyperintensity in the right ganglio-capsular region of the brain- likely gliosis (Red arrow).