Tuberculous Pneumonia as a Primary Cause of Acute Respiratory Distress Syndrome: A Case Report

Abstract

Background: Tuberculosis is an uncommon and very rare cause of Acute Respiratory Distress Syndrome.
Moreover, it has been associated with poor outcomes with a very high mortality rate (40-80%). The clinical
symptoms and radiological findings of tuberculous pneumonia that resemble bacterial pneumonia result
in difficulties to decide definitive diagnosis. Case Presentation: A 35-year-old male patient was admitted
to hospital with shortness of breath, fever, cough without expectoration. The patient had history of asthma
since childhood. Chest physical examination showed rhonchi and wheezing on both lungs. Initial laboratory
findings were leucocytosis, granulocytocis, eosinopenia, increased ALT and ALP levels, blood gas analysis
revealed acute respiratory failure. PaO2/FiO2 was 49 mmHg. ECG showed sinus tachycardia and chest
X-ray showed consolidation on both lungs. The patient was initially managed for asthma exacerbation and
bilateral pneumonia with ARDS. The result of microbiological findings showed acid fast bacilli (AFB)
positive. He had been treated with anti-TB first category. Clinical improvement was achieved after 1 week of
anti-TB treatment. Summary: Tuberculous pneumonia with ARDS is a rare case of pulmonary tuberculosis.
The diagnosis is established by a prompt and complete examination that lead to optimal treatment with
appropriate anti-TB.