Annals of Medicine and Surgery 62 (2021) 80–83 Available online 12 January 2021 2049-0801/© 2021 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Case Report COVID-19 and active primary tuberculosis in a low-resource setting: A case report Muhammad Anis Baskara a, * , Firdian Makrufardi b , Ardiana Dinisari c a House Offcer of Prambanan General Hospital, Yogyakarta, Indonesia b House Offcer of PKU Muhammadiyah Bantul General Hospital, Yogyakarta, Indonesia c Department of Internal Medicine, Prambanan General Hospital, Yogyakarta, Indonesia A R T I C L E INFO Keywords: COVID-19 Tuberculosis Low-resource setting Case report SARS-Cov-2 ABSTRACT Introduction and importance: Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness. But there are few studies that explain the clinical features of COVID-19 patients with active primary tuberculosis. In a low-resource setting, it is diffcult to distinguish the clinical characteristics of COVID- 19 from other respiratory diseases. Here, we briefy report the frst case of COVID-19 with active primary tuberculosis in our low-resource institution. Case presentation: A fourty two year old diabetic Indonesian male was admitted to emergency department in November 2020 due to vertigo-like dizzines for one week, tension type headache, shivering, cough with sputum, abdominal pain, and night sweats. Xpert MTB-RIF Assay G4 detect Mycobacterium Tuberculosis Bacteria (MTB) without rifampicin resistance, but the Tubex test for antibody IgM anti-O9 was negative. Patient admitted to isolation ward for suspected COVID-19 with separate rooms due to tuberculosis, until 24 hours evaluation of nasopharyng and oropharyng swab test performed. On the second day, the evaluation swab test was positive for COVID-19. Clinical discussion: Limited or no protection against COVID-19 is one of the problems that leads to co-infection. Now, there is no recommendation treatment for COVID-19 sufferer with tuberculosis co-infection or vice versa. Ventilation support and intensive care for infectious patient must be accessible, yet still unavailable in our institution. Conclusion: A low resource setting has its own challenges in handling COVID-19. Further studies are needed to address the clinical characteristics, diagnosis and management in COVID-19 patients with active tuberculosis. 1. Introduction Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) was reported in Wuhan, Hubei Province, China by the World Health Orga- nization (WHO) on December 31, 2019. Currently this virus is called COVID-19 and pose major public health and governance challenges [1]. As of 11 November, the Government of Indonesia announced 502,110 confrmed cases and 16,002 deaths, accompanied by issue of limited laboratory resources in some areas [2]. Due to resource limitations and challenges accessing adequate care, the low-resource setting pose the highest of morbidity and mortality in COVID-19 with tuberculosis infection [18]. Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness. The diffculty in distinguishing clinical characteristics of COVID-19 from other respiratory diseases was re- ported in a low-resource setting study [3]. A study of active tuberculosis in COVID-19 revealed unknown patient outcomes and the clinical fea- tures are not fully elucidated [4]. Previous studies have demonstrated that the presence of any comorbidity has been associated with a risk of developing acute respiratory distress syndrome [5]. Diabetes, hyper- tension, respiratory diseases, cardiac diseases, pregnancy, renal diseases and malignancy were the most common comorbidities that associated with poorer prognosis [6]. It has been hypothesized that infectious disease such as tuberculosis, caused by Mycobacterium tuberculosis could predispose to the development of COVID-19, but it not clearly under- stood [7]. Here, we briefy report the frst case of COVID-19 with active * Corresponding author. Prambanan General Hospital Jl, Prambanan-Piyungan Km, Delegan, Sumberharjo, Prambanan, Sleman, Daerah Istimewa Yogyakarta, 55572, Indonesia. E-mail address: anisbaskara15@gmail.com (M.A. Baskara). Contents lists available at ScienceDirect Annals of Medicine and Surgery journal homepage: www.elsevier.com/locate/amsu https://doi.org/10.1016/j.amsu.2020.12.052 Received 1 December 2020; Received in revised form 28 December 2020; Accepted 29 December 2020