Abstract
Miliary tuberculosis is an uncommon cause of Acute Respiratory Distress Syndrome (ARDS) with a high mortality. Early diagnosis and timely initiation of treatment are important for good outcome. We report a case of 23 years old female who needed admission to intensive care unit (ICU) due to ARDS. On routine investigations, the cause of ARDS could not be ascertained. Finally, high resolution computed tomography of chest and bronchoscopic guided lung biopsy were done which confirmed the etiology to be miliary tuberculosis. Patient showed improvement after starting anti-tubercular therapy with steroids. One week later, the patient’s condition was stabilized and was shifted out of ICU. This case report emphasizes that miliary tuberculosis, though difficult to diagnose, should always be considered a differential diagnosis in patients with ARDS, as early initiation of treatment can prove to be lifesaving.
Keywords: Miliary tuberculosis, acute respiratory distress syndrome, intensive care unit, antitubercular drug.
References
- Sharma SK, Mohan A, Sharma A. Challenges in the diagnosis and treatment of miliary tuberculosis. Indian J Med Res 2012; 135:703-30.
- Bhalla A, Mahapatra M, Singh R, Cruz SD. Acute lung injury in miliary tuberculosis. Ind J Tub 2002; 49:125.
- Mohan A, Sharma SK, Pande JN. Acute respiratory distress syndrome (ARDS) in miliary tuberculosis: a twelve-year experience. Indian J Chest Dis Allied Sci 1996; 38:157-62.
- Kim JY, Park YB, Sim YS, Kang SB, Shin JW, Park IW et al. Miliary tuberculosis and acute respiratory distress syndrome.Int J Tuberc Lung Dis 2003; 7:359-64.
- Mofredj A, Guérin JM, Kidouche R, Masmoudi R, Madec Y. Acute respiratory distress syndrome and pancytopenia during miliary tuberculosis in a HIV positive patient. Ann FrAnesthReanim 1996,15:1203–6.
- Davidson TA, Caldwell ES, Curtis JR. Reduced quality of life in survivors of acute respiratory distress syndrome compared with critically ill control patients. JAMA 1999; 281:354-60.
- Piqueras AR, Marruecos L, Artigas A, Rodriguez C. Miliary tuberculosis and adult respiratory distress syndrome. Intensive Care Med 1987; 13:175–82.
- Zang YM, Doerfler TC, Leu B, Guillenm B, Ron WN. Mechanism of stimulation of interleukin and l|3 and TNF-a by Mycobacterium tuberculosis components. JClin Invest 1993; 91:2076.
- Sharma SK, Mohan A, Pande JN, Prasad KL, Gupta AK, Khilnan GC. Clinical profile, laboratory characteristics and outcome in miliary tuberculosis. Q J Med 1995; 88:29-37.
- Marteens G, Willcox PA, Benatar SR. Miliary tuberculosis. rapid diagnosis, hematologic abnormalities, and outcome in 109 treated adults. Am J Med1990; 89:291–6.
- Roger PM, Deloffre P, Tiger F, Bernardin G, Corcelle P, Dellamonica P et al. Prognosis of adult respiratory distress syndrome in tuberculosis patients: 4 case reports. Presse Med1995; 24:1021–4.
- Benatar SR, McLoud TC, Mark EJ. Case 23, 1995: case records of the Massachusetts General Hospital. N Engl J Med1995; 333:241–8.
- Kim JH, Langston AA, Gallis HA. Miliary tuberculosis: epidemiology, clinical manifestations, diagnosis, and outcome. Rev Infect Dis 1990; 12:583-90.
- Sharma SK, Mohan A, Sharma A, Mitra DK. Miliary tuberculosis: new insights into an old disease. Lancet Infect Dis 2005; 5:415-30.
- Sharma SK, Mohan A. Miliary tuberculosis. In: Schlossberg D, editor. Tuberculosis and nontuberculous mycobacterial infections.6th ed. Washington: American Society for Microbiology Press; 2011. 415–35.
- Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN et al. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J RespirCrit Care Med 2003;167: 603–62.
- Meduri GU, Golden E, Freire AX, Taylor E, Zaman M, Carson SJ et al. Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. Chest 2007; 131:954–63.
Corresponding Author
Dr Divya Sethi
Employees’ State Insurance Postgraduate Institute of Medical Sciences and Research (ESI PGIMSR), New Delhi -110015, India