COVID-19 and Chronic Diabetes: The Perfect Storm for Reactivation Tuberculosis?

A Case Series

Genesis P. Aguillón-Durán; Ericka Prieto-Martínez; Doris Ayala; Juan García Jr.; John M. Thomas III; Juan Ignacio García; Brandon Michael Henry; Jordi B. Torrelles; Joanne Turner; Eder Ledezma-Campos; Blanca I. Restrepo


J Med Case Reports. 2021;15(621) 

In This Article

Case Presentation

Two males (43 and 44 years old) and one female (49 years old) presented with signs and symptoms suggestive of active TB (Table 1) to the Centro Regional de Tuberculosis in Reynosa, Tamaulipas. They reported no pulmonary symptoms prior to the development of a COVID-19 episode 3–6 months ago. Their COVID-19 symptoms gradually disappeared, except for a persistent dry cough that gradually evolved into a productive cough (60 days ago for TR-241 and TR-247 and 90 days ago for TR-243), and was accompanied by dramatic weight loss and the reappearance of fever and chills 14–15 days prior to reporting to the TB clinic. The three cases were diagnosed with pulmonary TB supported by abnormal chest x-rays, positive acid-fast sputum smears (> 10 bacilli/field), and culture confirmation of M. tuberculosis spp. Their previous infection with SARS-CoV-2 was confirmed by positive anti-SARS-CoV-2 IgG titers. Informed consent was obtained from both participants as part of a parent study.

Besides COVID-19, other host factors or medical conditions influencing TB risk were examined (Table 1). A consistent finding was a chronic history of type 2 diabetes (≥ 5 years) with poor glucose control (HbA1c ≥ 7.5%). We cannot ascertain whether these were cases of primary progressive TB disease or of an incipient TB that was smoldering at the time of the COVID-19 diagnosis, or if this was a reactivation of a latent M. tuberculosis infection prompted by the COVID-19 episode. We consider the latter is more likely given that: (i) none of the cases reported pulmonary symptoms prior to the COVID-19 episode, (ii) two had no knowledge of previous exposure to a TB patient and one had a past exposure (Table 1), and (iii) there was a gradual appearance of a productive cough and the reemergence of fever and chills after the COVID-19 episode was resolved.