Active pulmonary tuberculosis presenting with acute respiratory failure

Area of Science:

• Pulmonology
• Infectious Diseases
• Critical Care Medicine

Background:

• Acute respiratory failure (ARF) in patients with active pulmonary tuberculosis (PTB) is a critical condition.
• Bronchogenic PTB is an underrecognized cause of ARF, often presenting with symptoms that mimic acute febrile illness or diffuse interstitial lung disease.

Observation:

• Four patients with active PTB presented with ARF.
• Three patients exhibited acute symptoms (fever, dyspnea, hypoxemia) and diffuse radiographic infiltrates.
• One younger patient presented with lobar consolidation.

Findings:

• Diagnosis was confirmed via bronchoalveolar lavage fluid and transbronchial lung biopsy.
• All patients required intensive care management.
• Prompt antitubercular therapy resulted in clinicoradiological improvement.

Implications:

• Early recognition and diagnosis of bronchogenic PTB are crucial for managing ARF.
• Effective antitubercular treatment leads to favorable prognoses in patients with PTB-induced ARF.
• This case series highlights the importance of considering PTB in the differential diagnosis of ARF.