# Pulmonary and intestinal tuberculosis with COVID-19 complicated with fluidopneumothorax and colovesical fistula: The importance of diagnosis complexity in line with clinical setting

## TL;DR

A rare case of tuberculosis and COVID-19 complicated by hydropneumothorax and colovesical fistula is reported, emphasizing the need for accurate and timely diagnosis.

## Contribution

This case highlights the rare and complex interplay of TB, COVID-19, and associated complications requiring multidisciplinary management.

## Key findings

- The patient's condition improved with medical treatment without surgical intervention for the colovesical fistula.
- Early and accurate diagnosis is crucial for managing complex cases involving TB, COVID-19, and overlapping symptoms.
- Medical therapy can be effective for TB-related colovesical fistulas when there are no ongoing clinical symptoms.

## Abstract

The complication of hydropneumothorax and colovesical fistula is rare, especially in patients with tuberculosis (TB) and COVID-19. This particular situation poses a management difficulty, and can significantly threaten the patient's life without a clear diagnosis and timely treatment. We report a 28-year-old woman with pulmonary and intestinal TB with COVID-19 complicated with hydropneumothorax and colovesical fistula (CVF) which worsened her condition. Treatment for this patient was given according to the diagnosis. Her condition improved and she was discharged after 30 days of hospitalization, while elective surgery for CVF was not performed because there were no clinical symptoms complained of by this patient after completing TB treatment (9 months after hospital discharge). This case report highlights the importance of considering pulmonary and intestinal TB with COVID-19 as the cause of hydropneumothorax and CVF. Early and complex diagnosis is essential for proper management, as well as the efficacy of medical therapy and treatment for controlling such advanced stages of the disease. A complex condition with many symptoms can overlap with other diseases. Clinicians should consider the clinical symptoms, radiological imaging, and standard or supporting examination for accurate diagnosis to find the etiology of the diseases. Complete treatment for TB should be considered as the treatment choice (nonsurgical therapy) for CVF caused by TB before deciding on surgical intervention.