A 35-year-old man presented with a 10-day history of fever, headache, and dry cough. Physical examination was unremarkable. His baseline blood investigation was remarkable for high inflammatory markers and mild transaminitis. Chest X-ray revealed left mid-zone consolidation with a cavitary lesion. He was found to be positive for SARS-CoV-2 from nasopharyngeal swab PCR. Given the cavitary lesion, tuberculosis (TB) was suspected, and sputum smear acid-fast bacilli confirmed the presence of mycobacterial infection. Thus, the patient was treated as a case of COVID-19 pneumonia and active pulmonary TB. TB culture showed Mycobacterium tuberculosis sensitive for first-line anti-TB drugs. He later developed a rise in liver enzymes suspected to be either secondary to TB drugs versus COVID-19–related hepatitis. Subsequently, he was shifted temporarily to second-line antituberculosis therapy until improvement in his liver enzymes. Re-swabbing was performed as per the protocol, and the patient tested persistently positive for a total of 62 days.
A 53-year-old man, known to have HTN, DM, and end-stage renal disease (ESRD), presented with fever, abdominal pain, diarrhea, nausea, and vomiting. Physical examination revealed a tired-looking man with mild abdominal tenderness but was otherwise unremarkable. Abdominal computed tomography (CT) scan was performed to rule out causes of acute abdomen. It showed no abdominal pathology but numerous bilateral lungs’ basal patchy consolidations and ground-glass opacities. Subsequently, nasopharyngeal PCR confirmed COVID-19. He received the treatment guided by the local protocol, and he became symptom-free and was discharged home following negative swab PCR after 28 days. Eighteen days later, he again presented with fever, chest pain, and mild dyspnea. The chest X-ray showed bilateral lung infiltrates increasing compared with the previous Images. The initial test for COVID-19 was inconclusive; then, the repeat test was positive 2 days after the second hospital admission. He was restarted on the treatment protocol and continued to improve with an unremarkable hospital stay. The repeated test was negative after 1 week from the second presentation. The patient had 48 days elapsing from the first positive PCR result until the last positive sample.