Delayed death from pulmonary tuberculosis: unsuspected subtherapeutic drug levels

A patient with fulminant pulmonary tuberculosis died after 41 days of intensive care despite pansensitive organisms and no known underlying immunosuppression. Two factors leading to death in this patient were a delay in seeking medical attention and a subtherapeutic serum level of rifampin, though no obvious evidence of malabsorption existed. Malabsorption of antitubercular drugs is under-recognized and of extreme importance in the treatment of critically ill patients with active pulmonary tuberculosis. Factors associated with mortality from tuberculosis and selected aspects of critical care management are discussed.