Pandemic Influenza (H1N1) and Mycobacterium tuberculosis Co-infection
An 88-year-old woman was transferred to the ED on January, 2010 for suspected panperitonitis. She had been diagnosed with pneumonia during a prior hospital admission and reported that related symptoms improved after 14 days of intravenous ceftriaxone and metronidazole administration. Upon arrival, the patient complained abdominal pain, mild dyspnea, and sputum. The physical examination revealed no significant findings except for diffuse tenderness in her whole abdomen. Laboratory findings were as follows: WBC, 12,810/mm3; neutrophils, 89.2%; lymphocytes, 760/mm3 (6.0%); and CRP, 182 mg/L. Chest X-ray revealed a mass-like lesion in the left upper lung field, and subsequent chest CT revealed left bronchial wall narrowing and obstruction with distal consolidation. However, pH1N1 RT-PCR revealed a positive result in a nasopharyngeal specimen, and a conventional dose of oseltamivir was administered as along with piperacillin/tazobactam. The patient was thought to also have pseudomembranous colitis according to clinical presentation and abdomen CT finding, and abdominal pain was improved after administration of oral vancomycin.\nDespite administration of both anti-bacterial and anti-viral agents, pulmonary consolidation did not improve while dyspnea and sputum had been improving. After repetitive negative results of sputum AFB smear studies, growth of MTB was identified from the initial respiratory specimens on HOD 15. After administration of isoniazid, rifampin, ethambutol, and pyrazinamide, pulmonary infiltration observed via chest X-ray improved, and the patient was discharged without significant sequelae.