[Septic shock in a female patient with miliary tuberculosis]

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Pulmonology

Background:

• Pneumogenic sepsis and severe acute respiratory failure (ARF) can present fulminantly.
• Miliary tuberculosis is a rare cause of septic shock, particularly in regions with high hygiene standards.
• Pulmonary miliary tuberculosis carries a high mortality rate, especially when complicated by ARF.

Observation:

• A 36-year-old Indian female presented with rapid deterioration due to pneumogenic sepsis and severe ARF.
• Despite clinical suspicion, miliary tuberculosis was only confirmed during autopsy.
• The patient succumbed to multiorgan failure within 14 hours of intensive care unit admission.

Findings:

• The case underscores the diagnostic challenges of miliary tuberculosis presenting as severe sepsis and ARF.
• Miliary tuberculosis complicated by ARF has a significant mortality rate (60-90%).
• This case highlights the rarity of miliary tuberculosis causing septic shock in Europe due to stringent hygiene protocols.

Implications:

• Improved diagnostic strategies are needed for early identification of miliary tuberculosis in critically ill patients.
• Effective management protocols for open tuberculosis in intensive care units are crucial.
• This case emphasizes the importance of considering uncommon pathogens in severe sepsis, even in low-prevalence areas.