The development of early acute respiratory distress-syndrome and the collapse of the capsule of fibrous-focal pulmonary tuberculosis against the background of infection with COVID-19

Abstract

The article presents the results of clinical and pathomorphological studies of a patient who died from the rapid development of acute respiratory distress syndrome and the collapse of the capsule of fibrous-focal pulmonary tuberculosis against the background of COVID-19 infection.

Description of the case. Patient G.L., 48 years old, hospitalized for some hours on May 28, 2023 at the emergency hospital of the Ministry of Health of Chuvashia. Computed tomography revealed signs of bilateral viral interstitial pneumonia, the percentage of lung tissue damage was 61%. Signs of fibrous-focal tuberculosis were determined in the lower parts of the left lung. PCR analysis for COVID-19 was positive. The assessment of the condition on the NEWS2 scale was 11 points. In the general blood test: leukocytes: 14.3 (3.39–8.86) × 109/l, lymphocytes: 5 (19–37) %, ESR: 49 (2-15) mm / hour, D-dimer: 345 (0–250). Despite the started treatment, a fatal outcome suddenly occurred.

Conclusion. A case of a rare localization of pulmonary tuberculosis (S8–9), which proceeded for several years, is described. It should be noted the features of this form after infection with SARS-CoV-2: despite the favorable course of the process, signs of amyloidosis were determined in the vessels of the lungs. Against the background of COVID-19 infection, a disintegrated capsule with signs of tuberculous granulomatous inflammation noted in the lower parts of the lungs. Tuberculous caseous foci with exudative-productive inflammation along the periphery of the necrotic focus were determined. It should be noted that vessels with amyloid were detected with signs of alterative processes.