(1134) Acute Respiratory Distress Syndrome (ARDS) and Septic Shock Secondary to Pulmonary Tuberculosis (TB)

Introduction: TB, a global health concern, primarily affects the lungs. In rare cases, it can lead to ARDS and septic shock, posing significant management challenges. Exact prevalence of TB associated-ARDS is not well known. We explore the presentation, and management strategies for TB-induced ARDS and septic shock, highlighting the importance of early recognition, and need for a comprehensive approach.

Description: A 61-year-old male was brought to the hospital by emergency medical services after he was found unresponsive at home. He had been feeling unwell for the past four weeks, experiencing weight loss of about 30 pounds and persistent diarrhea that started a few days prior. Medical history included HIV and Hepatitis C. Upon examination, he was hypoxic with saturation around 90%, and with dyspnea, tachypnea, and tachycardia.
Chest radiography revealed numerous patchy focal infiltrates, bilateral interstitial/ground-glass opacities, as well as signs of emphysema, and cavitary lesions. Laboratory tests showed leukocytosis, elevated lactate, D-dimer, and LDH levels as well as undetectable CD4 count and a HIV viral load of 36,640.
Due to worsening hypoxia and severe metabolic acidosis, he was intubated and admitted to the intensive care unit. Both Acid-fast smear and Xpert/MTB/RIF assay confirmed the presence of Mycobacterium Tuberculosis, and he was started on RIPE therapy along with Levofloxacin.
Despite treatment, his hypoxia and metabolic derangements worsened. His pressor requirements also increased and radiographic findings were worsening. A proning maneuver with deep sedation and paralysis was attempted to improve oxygenation, but was unsuccessful. Despite extensive antibiotic therapy and intensive care, the patient's clinical status continued to worsen, and he eventually expired.

Discussion: ARDS due to TB is rarely reported but carries a high mortality rate up to 80%. Patients with disseminated TB are more likely to require mechanical ventilation. Effective management requires early detection and comprehensive care. Despite initiation of appropriate therapies and supportive measures, this patient continued to worsen, leading to severe outcomes, including cardiopulmonary decompensation and death.