Loutsou Maria, Georgakopoulou Vasiliki E, Roussakis Nikolaos, Chadia Konstantina, Steiropoulos Paschalis
Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, GRC.
Department of Pathophysiology/Pulmonology, Laiko General Hospital, Athens, GRC.
Cureus. 2024 Jul 3;16(7):e63791. doi: 10.7759/cureus.63791. eCollection 2024 Jul.
The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the diagnosis and management of tuberculosis (TB), a major public health issue. This case report discusses a 70-year-old female with post-polycythemia vera myelofibrosis (post-PV MF) treated with ruxolitinib who developed miliary TB amidst a COVID-19 infection. The patient presented with a flu-like syndrome over the past week with fatigue and weight loss the last month. When she was admitted to the hospital, the real-time polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive. Despite the typical COVID-19 presentation, her clinical and radiographic features raised suspicion for disseminated TB. Diagnostic tests, including bronchoscopy and PCR for , confirmed miliary TB. She was treated with a standard antitubercular regimen, leading to symptomatic improvement. The interplay between COVID-19 and TB is complex, with COVID-19-induced immunosuppression, particularly lymphocytopenia, facilitating TB reactivation. Additionally, ruxolitinib, a Janus kinase (JAK) inhibitor used for myelofibrosis, impairs immune defense mechanisms, increasing infection risk, including TB. Prompt and accurate diagnosis of TB in the context of COVID-19 is crucial for effective management and improved patient outcomes. Clinicians should remain vigilant for TB reactivation in patients undergoing treatments such as ruxolitinib and consider alternative diagnoses despite positive SARS-CoV-2 tests. This report highlights the necessity for a comprehensive evaluation and timely intervention to mitigate the compounded risks of COVID-19 and TB.
2019年冠状病毒病（COVID-19）大流行对结核病（TB）这一重大公共卫生问题的诊断和管理产生了重大影响。本病例报告讨论了一名70岁患有真性红细胞增多症后骨髓纤维化（post-PV MF）的女性，她接受了芦可替尼治疗，在COVID-19感染期间发生了粟粒性结核病。患者在过去一周出现类似流感的综合征，上个月有疲劳和体重减轻症状。入院时，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的实时聚合酶链反应（RT-PCR）呈阳性。尽管有典型的COVID-19表现，但她的临床和影像学特征引发了对播散性结核病的怀疑。包括支气管镜检查和针对[此处原文缺失相关内容]的PCR在内的诊断测试确诊为粟粒性结核病。她接受了标准的抗结核治疗方案，症状得到改善。COVID-19和结核病之间的相互作用很复杂，COVID-19引起的免疫抑制，尤其是淋巴细胞减少，促进了结核病的重新激活。此外，用于骨髓纤维化的Janus激酶（JAK）抑制剂芦可替尼会损害免疫防御机制，增加包括结核病在内的感染风险。在COVID-19背景下及时准确地诊断结核病对于有效管理和改善患者预后至关重要。临床医生应对接受芦可替尼等治疗的患者的结核病重新激活保持警惕，尽管SARS-CoV-2检测呈阳性，仍应考虑其他诊断。本报告强调了进行全面评估和及时干预以减轻COVID-19和结核病复合风险的必要性。
