Abstract
Although, miliary tuberculosis is an unusual cause of severe acute respiratory failure, we describe nine patients with miliary tuberculosis who developed adult respiratory distress syndrome. This complication occurred in seven patients despite treatment with antituberculous drugs. In two patients who developed the syndrome, miliary tuberculosis was diagnosed only at postmortem. The presence of pulmonary hypertension in all cases and disseminated intravascular coagulation in seven cases suggests a possible pathophysiologic relationship with severe pulmonary vascular damage. The high mortality rate (88.8%) was associated with nonpulmonary organ system failure. Miliary tuberculosis should be considered in patients with adult respiratory distress syndrome of unknown etiology, and simple diagnostic procedures such as sputum, bronchial brushing, and gastric examination should be followed by invasive diagnostic procedures to confirm this etiology. Since untreated miliary tuberculosis is usually fatal, early recognition of this disease is of great importance, and specific therapy may play a lifesaving role.
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References
Ashbaugh DG, Bigelow DB, Petty TL, Levine BE (1967) Acute respiratory distress in adults. Lancet 2:319
Bates JH (1979) Diagnosis of tuberculosis. Chest [Suppl] 6:757
Bell RC, Coalson JJ, Smith JD, Johanson WG (1983) Multiple organ system failure and infection in adult respiratory distress syndrome. Ann Intern Med 3:293
Berger HW, Samortin TG (1970) Miliary tuberculosis: Diagnosis methods with emphasis on the chest roentgenogram. Chest 58:586
Biehl JP (1958) Miliary tuberculosis. A review of sixty-eight adult patients admitted to a municipal general hospital. Am Rev Tuberc 77:605
Bobrowitz ID (1982) Active tuberculosis undiagnosed until autopsy. Am J Med 72:650
Bouget J, Thomas R, Guivarch G, Verger JP, Ramee MP, Cartier F (1982) Tuberculose pulmonaire aiguë difusse et insuffisance respiratoire aiguë (A propos de 28 observations). In: Expansion Scientifique Française (eds) Monographie de la Societé de Réanimation de Langue Française, Paris, p 43
Colbert N, Lemaire F, Trunet P, Carlet J, Lange F, Rapin M (1981) Syndrome de détresse respiratoire aiguë de l'adulte. Une cause rare: la tuberculose milaire. 4 observations. Nouv Press Med 10:3049
Dyer RA, Chapell WA, Potgieter PD (1985) Adult respiratory distress syndrome associated with miliary tuberculosis. Crit Care Med 13:12
Greene R, Zapol WM, Snider MT et al. (1981) Early bedside angiographic diagnosis of pulmonary vascular occlusion during acute respiratory failure. Am Rev Respir Dis 124:593
Grieco MH, Chmel H (1974) Acute Disseminated Tuberculosis as a diagnostic problem. A clinical study based on Twenty-eight cases. Am Rev Respir Dis 109:554
Homan W, Harman E, Braun N, Felton C, Kiny T, Smith J (1975) Miliary tuberculosis presenting as acute respiratory failure: treatment by membrane oxygenator and ventricle pump. Chest 67:366
Huseby JS, Hudson LD (1976) Miliary tuberculosis and adult respiratory distress syndrome. Ann Intern Med 85:609
Jacques J, Sloan JM (1970) The changing pattern of miliary tuberculosis. Thorax 25:237
Jardin F, Prost JF, Bazin M, Desfond P, Ozier Y, Margairaz A (1982) Modalités évolutives du syndrome de détresse respiratoire aiguë de l'adulte. Valeur pronostique d'un indice de gravité tiré de l'oxygénation artérielle. Nouv Presse Med 11:29
Johnston RN, Ritchie RT, Murray IHF (1963) Declining tuberculosis sensitivity with advancing age. Br Med J 3:720
Laurent S, Lagrange JL, Sereni D, Dhainaud JF, Laroche C, Monsallier JF (1981) Oedème pulmonaire lésionnel au cours d'une miliaire tuberculose. Nouv Presse Med 40:3318
Loyd JE, Newman JH, Brigham KL (1984) Permeability pulmonary edema. Diagnosis and management. Arch Intern Med 144:143
McClement JH, Renzetti AD, Carroll D, Himmelstein A, Cournand A (1951) Cardiopulmonary function in hematogenous pulmonary tuberculosis in patients receiving streptomycin therapy. Am Rev Tuberc 64:583
Munt PW (1972) Miliary Tuberculosis in the chemotherapy era: with a clinical review in 69 American adults. Medicine 51:139
Murray HW, Tuazon CU, Kirmani N, Sheagren JN (1978) The adult respiratory distress syndrome associated with miliary tuberculosis. Chest 73:37
Pasculle AW, Kapadia SB, Ho M (1980) Tuberculous bacillemia, hyperpyrexia and rapid death. Arch Intern Med 140:426
Petty TL, Fowler AA (1982) Another look at ARDS. Chest 1:98
Pontoppidan H, Huttemeier P, Quinn DA (1985) Acute respiratory failure: Etiology, demography and outcome. In: Zapol W, Falke K (eds) Acute respiratory failure, Dekker M, New York, p 1
Raimondi AC, Olmedo G, Roncoroni AJ (1978) Acute miliary tuberculosis presenting as acute respiratory failure. Intensive Care Med 4:207
Richart C, Roca MA, Pedro-Botet J, Morell F (1976) Nuevos aspectos diagnósticos de la tuberculosis miliar. Nuestra experiencia en 20 casos. Med Clin 5:220
Sahn SA, Neff TA (1974) Miliary tuberculosis. Am J Med 56:495
Steigbigel RT (1979) Mycobacterium tuberculosis: Clinical manifestations. In: Mandell GL, Douglas RG Jr, Bennet JE (eds) Principles and practice of infectious diseases. Wiley, New York, p 1939
Tobin MJ, Grenvik A (1984) Nosocomial lung infection and its diagnosis. Crit Care Med 3:191
Vallés J, Artigas A, Quintana MI, Castella J, Ausina V (1985) Síndrome de distress respiratorio del adulto e infección pulmonar. In: Lemaire F, Artigas A (eds) El síndrome de distress respiratorio agudo del adulto. Masson, Barcelona, p 53
Williams MH, Yoo OH, Kane C (1973) Pulmonary function in miliary tuberculosis. Am Rev Respir Dis 107:858
Zeitz SJ, Ostrow JH, Van Arsdel PP Jr (1972) Immunologic features of the anergic tuberculosis patient. J Allerg 49:93
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Piqueras, A.R., Marruecos, L., Artigas, A. et al. Miliary tuberculosis and adult respiratory distress syndrome. Intensive Care Med 13, 175–182 (1987). https://doi.org/10.1007/BF00254701
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DOI: https://doi.org/10.1007/BF00254701