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 previously healthy 46-year-old man presented with a 7-day history of fever, dry cough, and mild dyspnea. On examination, he was febrile, mildly tachypneic, tachycardic, but maintained oxygen saturation on room air. His chest X-ray revealed consolidation involving the left mid and lower zones. SARS-CoV-2 PCR tested positive, and he was started on COVID-19 management for pneumonia following local protocols. The repeated PCR tests were persistently positive for 47 days. The patient was discharged home, asymptomatic after negative PCR.