Reactivation of Latent Tuberculosis in a Patient with COVID-19 and Epstein-Barr Virus Coinfection: A Case Report

We describe the case of a 24-year-old woman who developed a swelling under her collarbone, along with fever, swollen lymph nodes, tiredness, and weight loss. These symptoms started about three months after she had a moderate COVID-19 infection. Blood tests showed a high white blood cell count, with more neutrophils and fewer lymphocytes, as well as high levels of inflammation markers. Serological and molecular diagnostics confirmed Epstein-Barr virus (EBV) reactivation.. Despite receiving antiviral and supportive treatment, her condition worsened. Advanced imaging showed that her lymph nodes remained swollen and started to break down. Doctors ruled out other possible causes, such as bacterial infections, blood cancers, autoimmune diseases, and cancer spread. A needle biopsy, combined with a special genetic test (PCR), confirmed the presence of Mycobacterium tuberculosis, the bacteria that cause tuberculosis. She started a standard tuberculosis treatment, which led to major improvement within two months. Her swollen lymph nodes shrank, and her inflammation markers returned to normal. This case shows how COVID-19-related immune system changes, EBV reactivation, and tuberculosis infection can be connected. It highlights the need for careful monitoring of patients with long-lasting swollen lymph nodes, especially those with weakened immune systems.