COVID-19, HIV-Associated Cryptococcal Meningitis, Disseminated Tuberculosis and Acute Ischaemic Stroke: A Fatal Foursome
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Date
2021-10-09Author
Bongomin, Felix
Sereke, Senai Goitom
Okot, Jerom
Katsigazi, Ronald
Kandole, Tadeo Kiiza
Oriekot, Anthony
Olum, Ronald
Atukunda, Angella
Baruch Baluku, Joseph
Nakwagala, Frederick
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Background: Several viral, bacterial and fungal co-infections have been associated with
increased morbidity and mortality among patients with COVID-19. We report a fatal case of
severe COVID-19 pneumonia in a patient with a recent diagnosis of advanced HIV disease
complicated by cryptococcal meningitis, disseminated tuberculosis and acute ischemic stroke.
Case Presentation: A 37-year-old Ugandan woman was diagnosed with HIV infection 8 days
prior to her referral to our center. She was antiretroviral naïve. Her chief complaints were
worsening cough, difficulty in breathing, fever and altered mental status for 3 days with
a background of a 1-month history of coughing with associated drenching night sweats and
weight loss. The reverse transcriptase–polymerase chain reaction for SARS-CoV-2 of her
nasopharyngeal swab sample was positive. Chest radiograph demonstrated military pattern
involvement of both lungs. The serum and cerebrospinal fluid cryptococcal antigen tests were
positive. Urine lipoarabinomannan and sputum GeneXpert were positive for Mycobacterium
tuberculosis. Computed tomography of the brain showed a large acute ischemic infarct in the
territory of the right middle cerebral artery. Regardless of the initiation of treatment, that is,
fluconazole 1200 mg once daily, enoxaparin 60 mg, intravenous (IV) dexamethasone 6 mg once
daily, oral fluconazole 1200 mg once daily, IV piperacillin/tazobactam 4.5 g three times daily and
oxygen therapy, the patient passed on within 36 hours of admission.
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