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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">SARS-CoV-2 pneumonia exceeded tuberculosis &#40;TB&#41; mortality&#44; contributing 1&#46;8 million deaths in 2020&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> TB may remain undiagnosed due to confusion between the clinical features of the 2 diseases and the lack of a specific radiological lesion&#46; Some evidences suggest that previous or current TB infection or disease is associated with poor COVID-19 outcomes as the same virus or immunomodulatory treatments could reactivate latent TB&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe a case of a 69 years old woman&#44; non-smoker&#44; Ecuadorian&#44; with a healthy active lifestyle&#44; with hypertension&#44; type II diabetes and autoimmune type I pancreatitis &#40;due to immunoglobulin G4 mediated disease&#41;&#46; His baseline treatment consisted of angiotensin converting enzyme inhibitors&#44; metformin and prednisone &#40;5<span class="elsevierStyleHsp" style=""></span>mg daily&#41;&#46; Patient also had an untreated latent TB infection &#40;LTBI&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In March 2020&#44; before the widespread use of COVID vaccines&#44; she developed severe COVID-19 pneumonia with requirements of mechanical ventilation for 10 days&#46; She received dexamethasone&#44; tocilizumab and broad spectrum antibiotic coverage&#46; She was discharged 22 days after ICU admission&#44; cured of all complications suffered &#40;urinary tract infection&#44; bilateral pneumothorax&#44; deep vein thrombosis&#41; One month after discharge&#44; she complained of persistent dyspnea mMRC II&#46; Her lung function tests showed decreased DLCO &#40;49&#37;&#41; with normal spirometry values&#46; Also&#44; her CT scan demonstrated nodular sharply defined masses in the upper left lobe &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Patient received conservative treatment&#46; Three months later a repeat CT demonstrated reduction of infiltrates with persistence of nodules&#46; Finally&#44; a CT guided biopsy was performed revealing extensive areas of necrosis and multiple epithelioid granulomas and a single positive Ziehl Neelsen bacillary structure&#46; The diagnosis was confirmed with the growth of <span class="elsevierStyleItalic">M&#46; tuberculosis</span> in 2 post-bronchoscopy sputums&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Tuberculosis and COVID-19 are airborne infectious diseases&#46; They mainly affect the respiratory system and manifest a classic triad of symptoms&#58; cough&#44; fever and dyspnea&#46; This initially makes differential diagnosis difficult&#44; especially in countries with a high incidence of tuberculosis&#44; which raises fears of an increase in diagnostic delay and treatment&#46; There are a lot of concerns due to the possible interactions between SARS-COV-2 infection and <span class="elsevierStyleItalic">M&#46; tuberculosis</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The convergence of the two diseases seems to indicate a pessimistic scenario&#58; can SARS-CoV-2 infection reactivate TB&#63; Is LTBI or active TB a risk factor for infection and progression to severe COVID-19 pneumonia&#63; What impact does the coincidence of both diseases have on mortality&#63;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Our patient had LTBI&#44; but any previous lesion suggestive of TB on CT&#46; It is quite likely that COVID-19 pneumonia or treatment with immunosuppressive drugs or both&#44; have favored the evolution of LTBI towards active disease&#46; Long term treatment with corticosteroids are a well-established predisposing factor of TB&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Nevertheless&#44; there is not enough literature to determine if the use of tocilizumab in patients with COVID-19 pneumonia can increase the risk of TB&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">This raises the need to assess and treat LTBI in patients with lung injuries secondary to COVID-19 susceptible to treatment with corticosteroids&#46; For all the above&#44; TB should be carefully evaluated in patient with COVID-19 pneumonia and therapeutic strategies should be adjusted accordingly to prevent the rapid development of active TB&#46; However&#44; there is still not enough evidence to understand the possible consequences of LTBI and the interactions between these major respiratory infectious killers&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financiation</span><p id="par0040" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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