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[Three cases of tuberculosis complicating acute respiratory distress syndrome]
1Division of Internal Medicine, Saga Medical School.
Abstract:
In this report, we describe three patients with pulmonary tuberculosis with acute respiratory failure with an extensive tuberculous consolidation in bilateral lung fields. Disseminated intravascular coagulation (DIC) was present in one patient and miliary tuberculosis in two patients. They all developed acute respiratory distress syndrome (ARDS), nessecitating management by mechanical ventilation with a combination therapy of antituberculous agents and methylprednisolone (m-PSL) pulse therapy. Only one patient survived in whom the PaO2/FiO2 ratio recovered rapidly after the initiation of therapy. Two patients whose systemic condition upon admission was critically ill eventually died of hepatic failure and bacterial pneumonia, even though ARDS and pulmonary tuberculosis were successfully treated. Prognosis of pulmonary tuberculosis complicating ARDS and DIC is poor, and these patients need systemic intensive treatment, in which m-PSL therapy may be beneficial.
Insights
Severe pulmonary tuberculosis with acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC) has a poor prognosis. Combination therapy including methylprednisolone (m-PSL) pulse therapy may offer a survival benefit in select cases.
Area of Science:
- Pulmonology
- Infectious Diseases
- Critical Care Medicine
Background:
- Pulmonary tuberculosis can lead to severe respiratory complications.
- Acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC) are life-threatening conditions that can complicate tuberculosis.
Observation:
- Three patients with extensive pulmonary tuberculosis and acute respiratory failure were studied.
- All patients developed ARDS, with one also having DIC and two presenting with miliary tuberculosis.
- Mechanical ventilation and a combination of antituberculous agents with methylprednisolone (m-PSL) pulse therapy were administered.
Findings:
- One patient survived with rapid improvement in oxygenation (PaO2/FiO2 ratio) after treatment initiation.
- Two critically ill patients died from hepatic failure and bacterial pneumonia, despite successful management of ARDS and tuberculosis.
- The study highlights the critical condition of patients with pulmonary tuberculosis complicated by ARDS and DIC.
Implications:
- Pulmonary tuberculosis with ARDS and DIC carries a grave prognosis.
- Systemic intensive treatment is crucial for these patients.
- Methylprednisolone (m-PSL) pulse therapy may be a beneficial adjunct in the management of severe pulmonary tuberculosis with ARDS.