Clinical case of concomitant tuberculosis and COVID-19 on the background of Churg-Strauss syndrome

Abstract

BACKGROUND. Tuberculosis (especially chemoresistant), coronavirus disease (COVID-19) and Churg-Strauss syndrome (CSS), both separately are serious illnesses, and in combination with each other (tuberculosis + COVID-19, COVID-19 + CSS). The analysis of the literature also indicates the difficulty of differential diagnosis between these diseases, as they have common clinical and radiological features. The outcome of treatment depends on timely and early diagnosis of each of these diseases with the prescription of corresponding therapy. We haven’t found in the available literature described cases of concomitant tuberculosis, COVID-19 and CSS, which may be interesting in terms of diagnostic vigilance of physicians of different specialties.
 OBJECTIVE. To demonstrate the features of the simultaneous course of tuberculosis and COVID-19 in a patient with CSS on the example of a clinical case of self-observation.
 RESULTS AND DISCUSSION. During the last 19 years of her life, the patient suffered from CSS. From the treatment she received only polcortolon, which was insufficient for such a serious disease. Whereas, according to the literature, for the treatment of eosinophilic granulomatous vasculitis not only glucocorticoids should be prescribed, but also immunosuppressants (cyclophosphamide for induction and azathioprine for maintenance therapy), mepolizumab and others. During these years, the patient developed lesions of the cardiovascular system (metabolic cardiomyopathy of ethanol and eosinophilic-granulomatous-vascular origin, myocardial fibrosis with arrhythmia, heart failure of 1st degree), gastrointestinal tract (chronic gastroduodenitis, peptic ulcer of the duodenum, gallstone disease, chronic calculous cholecystitis, chronic pancreatitis), urogenital system (chronic pyelonephritis), skin (autoimmune dermatitis, hemosiderosis), respiratory system (respiratory insufficiency of the 2nd degree, chronic allergic rhinosinusitis). COVID-19 and multidrug-resistant tuberculosis joined on the background of the depleted organism. COVID-19 treatment was effective. However, the treatment of multidrugresistant tuberculosis, which the patient received for 3 months, did not have a positive effect (negative radiological dynamics on the background of continued bacterial excretion). Renal dysfunction (creatinine >140 μmol/l) and peripheral eosinophilia also persisted during this period. According to the FFS lethal risk scale, the patient had two factors, which indicated a very severe flow of the disease and a high risk of death. Acute heart failure was the reason of death.
 CONCLUSIONS. CSS (eosinophilic granulomatous vasculitis) is a rare disease that requires timely, quality and proper treatment that will prevent the development of damage of various organs and body systems (especially cardiovascular and respiratory). The presented case demonstrates a very severe course of CSS with damage of many organs and body systems in the absence of proper treatment, which could lead to timely regression of vasculitis symptoms and improve the patient’s prognosis. On the background of this syndrome, COVID-19 and multidrug-resistant tuberculosis joined. However, death has occurred as a result of acute heart failure after 3 months, that was inevitable.