MISSED TB DIAGNOSIS DURING THE COVID-19 PANDEMIC: MYTH OR REAL

ABSTRACT

SESSION TITLE COVID-19 Case Report Posters 2 SESSION TYPE Case Report Posters PRESENTED ON 10/19/2022 1245 pm - 0145 pm INTRODUCTION: Miliary Tuberculosis (TB) is a rare disorder caused by the hematogenous dissemination of Mycobacterium tuberculosis. Patients infected with Mycobacterium tuberculosis can develop Miliary TB from primary infection or reactivation of a latent infection. Many patients with Miliary TB will present with symptoms of classic tuberculosis and in the pandemic time overlaps with symptoms of Covid-19. Since the Covid-19 pandemic the reported TB diagnosis fell 20% in 2020 and remained 13% lower in 2021 as compared to pre-COVID-19 pandemic. Decrease in cases may be due to pandemic-related mitigation efforts, such as social distancing and wearing masks. CASE PRESENTATION This patient is a 23-year-old undocumented male who presented to the ED, originally in January of 2021, with complaints of generally not feeling well. He reported feeling feverish and having a poor appetite for the past 2 weeks. At this visit, the patient received testing for COVID-19, Influenza and strep;all of which were negative. He was then discharged home and instructed to follow-up outpatient. In July of 2021, the patient again presented to the ED with complaints of weakness, fevers, cough, and weight loss that have progressively worsened. A chest x-ray and CT chest were performed at this time which were positive for innumerable bilateral upper lobe predominant peri-bronchial vascular nodular airspace opacities and patchy areas of consolidation with central cavitation, highly suspicious for tuberculosis. A QuantiFERON gold test was ordered and the patient underwent bronchoscopy. After 2 weeks of hospitalization, a NAAT test came back positive for Tuberculosis. At this point, the patient was immediately started on rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE). The patient received 2 weeks of RIPE treatment and after being hospitalized for 1 month, he was then discharged home on RIPE therapy with strict instructions to follow-up outpatient. DISCUSSION: Similarities in symptoms of TB and COVID-19 may mean that some people who have TB are being evaluated for COVID-19, but not tested for TB. The case was very unusual in that the infection of TB went undiagnosed during his initial emergency department (ED) during the Pandemic surges. It had not been discovered until presenting to the ED 5 months later with worsening symptoms. In presenting this case, we hope to further education on Miliary TB and prevent future missed diagnoses given the extremely infectious nature of the disease. CONCLUSIONS: The 2020 and 2021 declines may be related to factors associated with the COVID-19 pandemic like similarities in symptoms between COVID-19 and TB disease may have led to missed TB diagnoses;widespread disruptions to healthcare during the COVID-19 pandemic may have delayed TB diagnoses;and Efforts to prevent COVID-19, such as wearing masks and staying six feet away from others, may also reduce the spread of TB. Reference #1 Masahiro Narita, Grace Hatt, Katelynne Gardner Toren, Kim Vuong, Monica Pecha, John A Jereb, Neela D Goswami, Delayed Tuberculosis Diagnoses During the Coronavirus Disease 2019 (COVID-19) Pandemic in 2020—King County, Washington, Clinical Infectious Diseases, Volume 73, Issue Supplement_1, 15 July 2021, Pages S74–S76, https//doi.org/10.1093/cid/ciab387 Reference #2 Cleverley J, Piper J, Jones MM. The role of chest radiography in confirming COVID-19 pneumonia. BMJ 2020;370 m2426. Reference #3 https//www.cdc.gov/media/releases/2022/s0324-tuberculosis-covid-19.html DISCLOSURES No relevant relationships by Nawal Aamir No relevant relationships by Gabrielle Gerbino