[Severe respiratory failure with pulmonary tuberculosis during initial phase of chemotherapy]

In seven patients with tuberculosis required ventilatory assistance, in our IRCU at the Habikino Hospital, we found worsening of the findings on chest X-ray film and clinical status during initial phase of chemotherapy, although their sputum became negative for acid-fast bacilli. On admission, six of them had large infiltration with cavities and discharged a large number of bacilli with elevation of ESR and hypoalbuminemia. We could get four patents off ventilator after start of PEEP therapy and high dose corticosteroid therapy. But three of them died at last, because they developed severe respiratory failure again. Pulmonary histology was available in five patients. We found interstitial and intra-alveolar pulmonary edema, intra-alveolar organization, hyperplasia of alveolar wall, and hyaline membrane formation. These findings were compatible with diffuse alveolar damage.