Page 393 - Abstract Book KONIKA 18

Respirology

P-RES-007
Disseminated Tuberculosis Coinfection with Pyogenic Lung Abscess
Mimicking Malignancy in Female Adolescent

Fina Yusriy Yana, Rika Hapsari, Arda Pratama Putra Chafid, Retno Asih Setyoningrum
Department of Child Health, Faculty of Medicine Universitas Airlangga/Dr. Soetomo General Academic Hospital,
Surabaya, East Java, Indonesia

Abstract
Background Disseminated tuberculosis (TB) is an uncommon sequela of Mycobacterium TB (MTB) infection
with an incidence of less than 2% of all TB cases. Female adolescence is increasingly recognized as risk
period for disseminated TB infection and tends to coinfection with pyogenic lung abscess. The diagnostic
challenges associated with disseminated TB which are coinfected with pyogenic lung abscess is tends to be
misdiagnosed with malignancy. Objective To present a case of disseminated TB coinfection with pyogenic
lung abscess mimicking malignancy in female adolescent. Case A 15-year-old female presented with chronic
productive cough, localized pain on right back, and weight loss. Chest X-ray revealed infiltrate and multiple
mass mimics lung carcinoma with metastatic process. Tuberculin skin test revealed 16 mm of induration.
Laboratory workup revealed leukocytosis and elevated C-reactive protein. GeneXpert MTB/RIF assay of
sputum and paravertebral abscess revealed MTB detected. Sputum culture revealed Klebsiella pneumonia.
The pathologic examination of paravertebral abscess revealed chronic granulomatous as tuberculosis process.
The chest MSCT revealed lung tuberculosis, multiple abscess formation in pre-paravertebral of thoracal
space, and ribs destruction. The chest MRI revealed multiple intraosseous abscesses, bone destructions,
narrowing discus, and paravertebral abscess formation. She responded well with antituberculosis drugs,
parenteral antibiotic, and brace. Conclusion Disseminated TB in adolescent females is tent to coinfection
with pyogenic lung abscess.
Keywords: disseminated tuberculosis; pyogenic lung abscess; mimicking malignancy; female
adolescent

P-RES-008
COVID-19 Co-Infection with Dengue and Thyphoid Fever in A Young Girl:
A Case Report

Fitrayani Hamzah, Amiruddin Laompo, Ninny Meutia Pelupessy, Husein Albar
Department of Children’s Health, Faculty of Medicine, Universitas Hasanuddin/Dr. Wahidin Sudirohusodo Hospital,
Makassar, South Sulawesi, Indonesia
Abstract
Background SARS-CoV-2 Co-infections have been reported to have various symptoms, from isolated
respiratory infection to symptoms related with other infections like dengue hemorrhagic fever and typhoid
fever. Similar symptoms and laboratory findings between dengue and other type of infection with COVID-19
pose a diagnostic challenge in endemic dengue region. Coinfections with different pathogens may result
in complex and unpredictable consequences on severity. Objective To report SARS-CoV-2 infection with
probable dengue and typhoid fever in 3 years old girl Case We report the case of a 3-year-old girl referred
from regional hospital with history of continuous fever, anorexia, headache, and gastrointestinal bleeding since
5 days at tertiary hospital before admission. Upon admission, laboratory finding revealed thrombocytopenia,
increased hematocrit, IgM and IgG dengue were negative. COVID-19 test by RT-PCR method is a routine
test performed in our hospital. Although the patient showed no respiratory symptom and chest X-ray was
normal without any ground glass opacities nor consolidations, her COVID-19 test turned out to be confirmed
Covid-19. Laboratory for IgM anti-salmonella was examined due to persistent fever during with the result
positive/6, liver function and D-dimer test were both increased. During hospitalization she was treated with
antibiotic ceftriaxon, antivirus, antipyretic, and multivitamins. Conclusion In endemic areas where arboviruses
and COVID-19 may coexist, clinical diagnosis is difficult. Distinction between dengue fever or typhoid
fever and COVID-19’s clinical features may be challenging as both infections share similar symptoms and
laboratory features in early phase. This is a challenge for clinician to asses.
Keywords: COVID-19; dengue fever, typhoid fever; co-infection

KONIKA XVIII Abstract Book 345