Severe ARDS Complicated by Active Pulmonary Tuberculosis and Recurrent Nosocomial Infections: Therapeutic Challenges and Clinical Outcomes

TL;DR

This paper discusses the challenges of treating a rare case of ARDS caused by tuberculosis and complicated by other infections and diabetes.

Contribution

The paper highlights the importance of early TB detection and multidisciplinary ICU care in managing complex ARDS cases.

Findings

Early bronchoscopy and GeneXpert testing enabled timely anti-TB treatment initiation.

Multidisciplinary care led to ventilator weaning and functional recovery despite complications.

The patient experienced two episodes of ventilator-associated pneumonia and gastrointestinal bleeding.

Abstract

Background: Acute respiratory distress syndrome (ARDS) secondary to tuberculosis (TB) is rare and associated with high mortality. Management is further complicated by comorbidities and ICU-related complications. Methods: We report a 43-year-old woman with post-polio sequelae and uncontrolled diabetes who developed ARDS due to pulmonary TB, complicated by recurrent nosocomial infections and gastrointestinal bleeding. Early bronchoscopy and GeneXpert MTB/RIF PCR were performed on ICU Day 2, enabling anti-TB therapy initiation by ICU Day 3. The patient received lung-protective ventilation, prone positioning, tailored antibiotics, and multidisciplinary care. Results: The patient’s clinical course was complicated by two episodes of ventilator-associated pneumonia and gastrointestinal bleeding, but with individualized management, she achieved ventilator weaning and functional recovery. Conclusions: Early TB recognition in ARDS is crucial. Multidisciplinary ICU management, including prudent steroid use, improves outcomes.

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