ACTIVE TUBERCULOSIS (TB) MASQUERADING AS AN ASTHMA EXACERBATION DURING A SARS-COV-2 (COVID 19) PANDEMIC

Introduction: TB rarely presents as asthma Clinical symptoms of COVID-19 and asthma can mask a diagnosis of TB Case Description: A sixty-year old male presented to the allergy clinic in the spring of 2019 complaining of nasal congestion and cough associated with shortness of breath Skin prick testing confirmed tree pollen allergy The patient was treated for seasonal asthma and allergic rhinitis with nasal fluticasone spray, montelukast and inhaled albuterol His symptoms improved, and he did well until this spring, when he contacted us with similar complaints without fever Patient was evaluated at a televisit, medications were renewed and he was referred for COVID 19 testing which was negative Since cough and shortness of breath persisted he was prescribed prednisone for a possible asthma exacerbation and amoxicillin for sinusitis The patient did not improve and was seen in person He was diaphoretic but not febrile or hypoxic Twenty pounds of unintentional weight loss was recorded, the rest of exam was not contributory Chest X-ray revealed bilateral pneumonia in upper lung lobes and laboratory data was significant for leukocytosis with lymphopenia, increased inflammatory markers and positive quantiferon Repeated COVID-19 test was negative Sputum revealed Mycobacterium Tuberculosis Patient was treated for TB and improved Conclusion: Physicians must be mindful of the rare possibility of TB in patients who present as COVID-19 associated respiratory symptoms or asthma exacerbation Prompt diagnosis and treatment of TB is crucial for the affected individual and community