Miliary tuberculosis presenting with acute respiratory distress syndrome in a patient with down syndrome
Introduction. Miliary tuberculosis (TB) is a rare and potentially fatal form of disseminated TB. It is caused by a widespread haematogenous dissemination of Mycobacterium tuberculosis from an active caseous focus to different organs. Sometimes it can have an acute presentation with a rapidonset clin...
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Military Health Department, Ministry of Defance, Serbia
2020-01-01
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| Series: | Vojnosanitetski Pregled |
| Subjects: | |
| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2020/0042-84501800108N.pdf |
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| author | Novković Ljiljana Lazić Zorica Petrović Marina Vujić Ana Stojković Anđelka Čekerevac Ivan |
| author_facet | Novković Ljiljana Lazić Zorica Petrović Marina Vujić Ana Stojković Anđelka Čekerevac Ivan |
| author_sort | Novković Ljiljana |
| collection | DOAJ |
| description | Introduction. Miliary tuberculosis (TB) is a rare and potentially fatal form of disseminated TB. It is caused by a widespread haematogenous dissemination of Mycobacterium tuberculosis from an active caseous focus to different organs. Sometimes it can have an acute presentation with a rapidonset clinical deterioration and death. Miliary TB complicated with an acute respiratory distress syndrome (ARDS) requiring mechanical ventilation (MV) is rare, even in countries with a high incidence of TB. Case report. A 35-yearold woman with Down syndrome (DS) was admitted to the Clinic for Pulmonology, Clinical Centre Kragujevac, due to an evaluation of cough and weight loss during last 2 months. Laboratory findings revealed anaemia, leukocytosis, elevated C-reactive protein (CRP) and hypoalbuminemia. A chest x-ray showed bilateral reticulonodular shadows, predominantly in the mid and lower right lung lobes. A purified protein derivative (PPD) skin test and induced sputum smear for acid-fast bacilli (AFB) were both negative. On the fifth day following admission, her health condition suddenly declined, and after developing a moderate ARDS, she was put on the mechanical ventilation. Due to a high clinical suspicion of miliary TB and the fact that her life was compromised, an empirical anti-tuberculosis therapy was initiated. Despite all therapeutic and supportive measures, the patient expired 3 days later. The diagnosis of miliary TB was established post-mortem. Conclusion. Miliary TB should be kept in mind in patients with DS due to immunosuppression associated with deficient cell-mediated immunity. The development of ARDS as a complication of miliary TB is difficult to identify due to a low causal association. High clinical suspicion and a chest radiograph with a typical appearance of miliary pattern justify the initiation of empirical anti-tuberculosis treatment in such patients, as an attempt to change poor prognosis. |
| first_indexed | 2024-12-15T00:48:41Z |
| format | Article |
| id | doaj.art-4f59ce8259724013aa0474c62ced4212 |
| institution | Directory Open Access Journal |
| issn | 0042-8450 2406-0720 |
| language | English |
| last_indexed | 2024-12-15T00:48:41Z |
| publishDate | 2020-01-01 |
| publisher | Military Health Department, Ministry of Defance, Serbia |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj.art-4f59ce8259724013aa0474c62ced42122022-12-21T22:41:29ZengMilitary Health Department, Ministry of Defance, SerbiaVojnosanitetski Pregled0042-84502406-07202020-01-0177665165610.2298/VSP180129108N0042-84501800108NMiliary tuberculosis presenting with acute respiratory distress syndrome in a patient with down syndromeNovković Ljiljana0Lazić Zorica1Petrović Marina2Vujić Ana3Stojković Anđelka4Čekerevac Ivan5University of Kragujevac, Faculty of Medical Science, Clinical Centre Kragujevac, Clinic for Pulmonology, Kragujevac, SerbiaUniversity of Kragujevac, Faculty of Medical Science, Clinical Centre Kragujevac, Clinic for Pulmonology, Kragujevac, SerbiaUniversity of Kragujevac, Faculty of Medical Science, Clinical Centre Kragujevac, Clinic for Pulmonology, Kragujevac, SerbiaUniversity of Kragujevac, Faculty of Medical Science, Clinical Centre Kragujevac, Department of Pediatrics, Kragujevac, SerbiaUniversity of Kragujevac, Faculty of Medical Science, Clinical Centre Kragujevac, Department of Pediatrics, Kragujevac, SerbiaUniversity of Kragujevac, Faculty of Medical Science, Clinical Centre Kragujevac, Department of Pediatrics, Kragujevac, SerbiaIntroduction. Miliary tuberculosis (TB) is a rare and potentially fatal form of disseminated TB. It is caused by a widespread haematogenous dissemination of Mycobacterium tuberculosis from an active caseous focus to different organs. Sometimes it can have an acute presentation with a rapidonset clinical deterioration and death. Miliary TB complicated with an acute respiratory distress syndrome (ARDS) requiring mechanical ventilation (MV) is rare, even in countries with a high incidence of TB. Case report. A 35-yearold woman with Down syndrome (DS) was admitted to the Clinic for Pulmonology, Clinical Centre Kragujevac, due to an evaluation of cough and weight loss during last 2 months. Laboratory findings revealed anaemia, leukocytosis, elevated C-reactive protein (CRP) and hypoalbuminemia. A chest x-ray showed bilateral reticulonodular shadows, predominantly in the mid and lower right lung lobes. A purified protein derivative (PPD) skin test and induced sputum smear for acid-fast bacilli (AFB) were both negative. On the fifth day following admission, her health condition suddenly declined, and after developing a moderate ARDS, she was put on the mechanical ventilation. Due to a high clinical suspicion of miliary TB and the fact that her life was compromised, an empirical anti-tuberculosis therapy was initiated. Despite all therapeutic and supportive measures, the patient expired 3 days later. The diagnosis of miliary TB was established post-mortem. Conclusion. Miliary TB should be kept in mind in patients with DS due to immunosuppression associated with deficient cell-mediated immunity. The development of ARDS as a complication of miliary TB is difficult to identify due to a low causal association. High clinical suspicion and a chest radiograph with a typical appearance of miliary pattern justify the initiation of empirical anti-tuberculosis treatment in such patients, as an attempt to change poor prognosis.http://www.doiserbia.nb.rs/img/doi/0042-8450/2020/0042-84501800108N.pdfdown syndrometuberculosis, miliaryrespiratory distress syndrome, adult |
| spellingShingle | Novković Ljiljana Lazić Zorica Petrović Marina Vujić Ana Stojković Anđelka Čekerevac Ivan Miliary tuberculosis presenting with acute respiratory distress syndrome in a patient with down syndrome Vojnosanitetski Pregled down syndrome tuberculosis, miliary respiratory distress syndrome, adult |
| title | Miliary tuberculosis presenting with acute respiratory distress syndrome in a patient with down syndrome |
| title_full | Miliary tuberculosis presenting with acute respiratory distress syndrome in a patient with down syndrome |
| title_fullStr | Miliary tuberculosis presenting with acute respiratory distress syndrome in a patient with down syndrome |
| title_full_unstemmed | Miliary tuberculosis presenting with acute respiratory distress syndrome in a patient with down syndrome |
| title_short | Miliary tuberculosis presenting with acute respiratory distress syndrome in a patient with down syndrome |
| title_sort | miliary tuberculosis presenting with acute respiratory distress syndrome in a patient with down syndrome |
| topic | down syndrome tuberculosis, miliary respiratory distress syndrome, adult |
| url | http://www.doiserbia.nb.rs/img/doi/0042-8450/2020/0042-84501800108N.pdf |
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