Severe COVID-19 infection in a lupus nephritis patient on treatment for multidrug-resistant disseminated tuberculosis
- Author:
Vincent M. Luceño
1
;
Leonid D. Zamora
1
;
Sandra V. Navarra
1
Author Information
- Publication Type:Case Reports
- Keywords: severe covid-19 infection; management challenge
- MeSH: Lupus Nephritis; Tuberculosis, Multidrug-Resistant
- From: Philippine Journal of Internal Medicine 2024;62(2):106-109
- CountryPhilippines
- Language:English
-
Abstract:
Background:Systemic lupus erythematosus is a multisystem autoimmune disease with variable manifestations, dysregulated type I interferon responses, and defective immune tolerance mechanisms. SLE, multidrug-resistant tuberculosis (MDR-TB), and coronavirus disease 2019 infection may be a rare, complex combination presenting a significant challenge in screening, management, and infection control.
Case:A 24-year-old female diagnosed with SLE nephritis maintained on mycophenolate, mofetil, and hydroxychloroquine developed disseminated multidrug-resistant tuberculosis (MDR-TB) involving the lungs, liver, and lymph nodes. She was started on an anti-TB regimen. However, QT prolongation and heart failure was noted, thus discontinuation of HCQ. On the 10th month of treatment with clofazimine, cycloserine, p-aminosalicylic acid, and delamanid, she developed fever, dyspnea, chest pain, and disorientation accompanied by progressive oxygen desaturation. A nasopharyngeal swab for SARS-CoV-2 RT-PCR was positive, and a high-resolution chest CT showed new peripheral ground-glass opacities consistent with COVID-19 pneumonia. Oxygen support with a high-flow nasal cannula at 60% FiO2, low molecular weight heparin, meropenem, remdesivir, and dexamethasone were given; MDR-TB treatment was temporarily withheld. The patient recovered after 3 weeks of hospitalization, and MDR-TB treatment was resumed following hospital discharge.
Conclusion:This case illustrates the challenges in healthcare access brought about by the pandemic and the management of drug-to-drug interactions in the different treatment regimens for lupus nephritis, disseminated MDRTB, and severe COVID-19 infection. - Full text:20241101025245711876 2023-237 Case OK.pdf
