National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 24 1 2025 01 01 Invasive Pulmonary Aspergillosis and Tuberculosis after COVID-19 102 105 733726 EN Mahshid Talebi-Taher Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases, School of Medicine, Iran University of Medical Sciences, Tehran, Iran 0000-0002-3133-7859 Seyed- Ali Javad-Moosavi Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran 0000-0001-6870-4029 Shirin Ahmadalipour Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran 0009-0003-6402-1329 Masoud Bahrami School of Medicine, Iran University of Medical Sciences, Tehran, Iran 0009-0009-8892-0525 Maryam Sarkheil Department of Infectious Diseases, School of Medicine, Iran university of Medical Sciences, Tehran, Iran. 0009-0005-6099-4742 Arash Javad-Moosavi Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran 0009-0002-7438-664x Journal Article 2023 11 23 Background: Pulmonary tuberculosis (TB) and invasive aspergillosis are distinct infectious diseases that rarely coexist in the same patient. The concurrent occurrence of these infections presents diagnostic and therapeutic challenges, resulting in complex clinical presentations and potentially adverse outcomes. We present a case report highlighting the diagnostic process, management strategies, and pertinent literature regarding the simultaneous occurrence of pulmonary TB and aspergillosis in a patient following COVID-19 infection. Case Presentation: A 55-year-old male with a history of occupational exposure as a farmer and welder presented with a complex medical condition. He had a previous COVID-19 infection and was hospitalized for three weeks, receiving appropriate treatment. Subsequently, he developed dyspnea and bilateral pleural effusion and underwent treatment with broad-spectrum antibiotics. Further investigations revealed consolidation in the left upper lobe, and biopsy confirmed the presence of Aspergillus species. The patient received voriconazole treatment for several months, but minimal improvement was observed. Recurrent hemoptysis prompted bronchoscopy, which showed positive results for acid-fast bacilli smear and TB PCR testing, indicating concomitant pulmonary TB. Anti-tuberculosis treatment was initiated alongside ongoing management for aspergillosis. Conclusion: This case report illustrates the diagnostic and therapeutic complexities associated with the simultaneous occurrence of pulmonary TB and aspergillosis in a patient following COVID-19 infection. Clinicians should maintain a high index of suspicion for dual infections in similar clinical scenarios. Prompt recognition, accurate diagnosis, and individualized treatment strategies are crucial for optimal patient management. Further research is warranted to enhance our understanding of this unique clinical entity and improve patient outcomes.

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