This is a 65-year-old man known to have chronic myeloid leukemia (CML) on dasatinib. He presented with a short history of fever, productive cough, and dyspnea. The examination revealed low-grade fever, tachycardia, and bilateral rhonchi on chest examination. Chest X-ray showed bilateral lower lobe consolidation with effusion. SARS-CoV-2 PCR was positive, and he was subsequently diagnosed as a severe case of COVID-19 pneumonia and received antibiotics and antiviral drugs. His condition deteriorated further during his stay, requiring noninvasive ventilation and ICU admission for 7 days. He eventually improved and was stepped down to the general medical wards for post-ICU care. He continued to have positive PCR for 54 days from the initial positive test.
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.