Development of Disseminated Drug resistant Tuberculosis in an Immunocompetent Patient after COVID-19 Infection

  • Vinita Tripathy Senior Resident, Department of Paediatrics, GGMC & JJH, Mumbai, India.
  • Bela Verma Professor and HOD, Department of Paediatrics, GGMC & JJH, Mumbai, India.
Keywords: Disseminated TB, Drug Resistant TB, COVID-19 Pandemic, Paediatric TB, Post-COVID MIS-C


Background: The COVID-19 pandemic which has spread at an alarming pace over the last 2 years has mutualism with yet another older, and often overlooked airborne disease, tuberculosis. The repercussions of the COVID-19 pandemic, with multiple waves making the situation even worse and our worldwide response to it with lockdowns, are in all probability going to leave an extreme and persistent effect on the diagnosis as well as control of TB. It is expected to lead to a further 6.3 million more cases of TB along with an extra 1.4 million deaths because of TB in the duration of 2020 to 2025. We present the following case which shows a rapid development of disseminated TB after COVID-19 infection in an otherwise immunocompetent child.
Case Report: An 11-year-old, female child, came with complaints of fever for 2 months and productive cough for 15 days. On evaluation, the child had tachypnoea and pallor with bilateral coarse crepitations. Her SpO2 was 94%. Chest X-ray was suggestive of miliary shadows. Sputum for gene Xpert was positive for MTB with rifampicin resistance. CT brain revealed ring-enhancing lesions with perilesional oedema with shaggy meningeal enhancement. CECT thorax and abdomen showed diffuse miliary nodules with necrotic mediastinal lymphadenopathy and bilateral bulky kidneys with cortical hypodense areas, and early features of pyelonephritis. Urine gene Xpert was also positive for MTB with rifampicin resistance. An ophthalmic examination revealed multiple choroid tubercles. Her COVID-19 antibodies came positive with high inflammatory markers pointing towards post-COVID MIS-C.
Conclusion: She was treated with DR-TB regimen and for MIS-C. She showed clinical and radiological improvement and was discharged on ATT.

How to cite this article:
Tripathy V, Verma B. Development of Disseminated Drug resistant Tuberculosis in an Immunocompetent Patient after COVID-19 Infection. Postgrad J Pediatr Adol Med. 2022;1(2):26-29.


Hennon TR, Penque MD, Abdul-Aziz R, Alibrahim OS, McGreevy MB, Prout AJ, Schaefer BA, Ambrusko SJ, Pastore JV, Turkovich SJ, Gomez-Duarte OG, Hicar MD. COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; a Western New York approach. Prog Pediatr Cardiol. 2020 May 23;57:101232. [PubMed] [Google Scholar]

Udwadia ZF, Vora A, Tripathi AR, Malu KN, Lange C, Raju RS. COVID-19 tuberculosis interactions: when dark forces collide. Indian J Tuberc. 2020 Dec;67(4S):S155-S162. [PubMed] [Google Scholar]

Diao B, Wang C, Tan Y, Chen X, Liu Y, Ning L, Chen L, Li M, Liu Y, Wang G, Yuan Z, Feng Z, Zhang Y, Wu Y, Chen Y. Reduction and functional exhaustion of T Cells in patients with Coronavirus Disease 2019 (COVID-19). Front Immunol. 2020 May 1;11:827. [PubMed] [Google Scholar]