Case report: Covid-19 and disseminated tuberculosis coinfection unveiling catastrophic antiphospholipid antibody syndrome: An association or de novo phenomenon
International Journal of Rheumatic Diseases
; 26(Supplement 1):337.0, 2023.
Article
in English
| EMBASE | ID: covidwho-2236175
ABSTRACT
Background:
Disseminated infections such as tuberculosis are known to result in a systemic inflammatory response leading to thrombosis, with increasing reported cases of thrombotic event being observed in patients infected with covid-19. This is the first reported case on co-infection with COVID-19 pneumonia and disseminated tuberculosis causing catastrophic antiphospholipid syndrome (CAPS). Method(s) The report highlighted the challenges in the diagnosis and management which include the use of corticosteroid in setting of systemic infections. Another diagnostic dilemma was to explain the cause of myositis by tuberculous or autoimmune. Case Presentation We report a 26-year- old man with HbE trait thalassemia who reported unintentional weight loss, night sweats for 1 month prior to the diagnosis of covid-19 infection on 10th March 2022. Seven days later, he was hospitalized for suspected perforated appendix. Computed tomography (CT) abdomen revealed hepatosplenomegaly, prostatitis, seminal vesiculitis. Multiple matted abdominal lymph nodes were not amenable for biopsy. Soon, he appeared toxic, dyspneic required non-invasive ventilation with bilateral parotitis. He had raised erythrocyte sedimentation (ESR) 52 mm/hour, C-reactive protein (CRP) 221 mg/dl, lactate dehydrogenase (LDH) 730U/L. Direct Coomb's antibody was positive but did not have any form of haemolysis. Complement 3 (0.45 g/L) and complement 4 (0.1 g/L) levels were low. Serum IgG4, procalcitonin, anti-nuclear antibody, cultures and virology were negative. Sputum for acid fast bacilli (AFB) was positive on Auramine O stain but the Ziehl-Nelson (ZN) stain and tuberculous PCR (GeneXpert) were negative. Diagnosis of disseminated tuberculosis was made but his abdominal pain persisted despite being on anti-tuberculous therapy (ATT), and he had new evidence of splenic infarct. CT angiogram also revealed celiac trunk and superior mesenteric artery thrombosis. Antiphospholipid (aPL) test was positive for lupus anticoagulant, beta 2 glycoprotein 1 and anti-cardiolipin antibodies. Therapeutic anticoagulation and plasma exchange were initiated for probable CAPS followed by intravenous immunoglobulin and corticosteroid. Thereafter, the patient developed severe bilateral pelvic girdle pain with evidence of myositis on the MRI (Figure 2). Serum creatine kinase was never elevated. Anti-PL- 7 and anti Ro-52 were borderline elevated. He recovered well and ambulant before discharged home. Conclusion(s) Our case highlight the complexicity of presentation of CAPS who manifested as multiple arterial thrombosis. The diagnosis of disseminated tuberculosis relied strongly on microbiological, imaging and clinical presentation as histopathological evidence was not feasible. Management challenges were deciding on corticosteroid in disseminated infection and the need for confirmation of persistent positive aPL test and to monitor myositis symptom to help guide decision making. (Figure Presented).
abdominal pain; adult; anticoagulation; appendix; artery thrombosis; Bacilli; bacterium culture; body weight loss; case report; catastrophic antiphospholipid syndrome; celiac artery; clinical article; coinfection; computer assisted tomography; conference abstract; coronavirus disease 2019; creatine kinase blood level; decision making; diagnosis; erythrocyte sedimentation rate; hemolysis; hepatosplenomegaly; histopathology; human; human tissue; lymph node; male; miliary tuberculosis; myositis; night sweat; nonhuman; noninvasive ventilation; nuclear magnetic resonance imaging; parotitis; pelvic girdle pain; plasma exchange; polymerase chain reaction system; prostatitis; sepsis; spleen infarction; sputum; superior mesenteric artery thrombosis; thalassemia; tuberculosis; virology; antinuclear antibody; auramine; beta2 glycoprotein 1; C reactive protein; cardiolipin antibody; complement component C3; complement component C4; corticosteroid; endogenous compound; hemoglobin E; human immunoglobulin; immunoglobulin G4; lactate dehydrogenase; lupus anticoagulant; phospholipid antibody; procalcitonin
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Case report
/
Prognostic study
Topics:
Long Covid
Language:
English
Journal:
International Journal of Rheumatic Diseases
Year:
2023
Document Type:
Article
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