A case of severe pulmonary tuberculosis with septic shock and ARDS

A 69-year-old man visited another hospital due to dyspnea and bloody sputum. A diagnosis of pulmonary tuberculosis was given because of multiple nodular shadows and consolidation on chest radiography and positive testing for acid-fast bacilli in his sputum; he was then referred to our hospital for treatment. Despite antituberculosis chemotherapy with isoniazid, rifampicin and ethambutol, his general condition worsened. On the 10th hospital day he needed mechanical ventilation and circulatory control in the intensive care unit. We diagnosed pulmonary tuberculosis complicated with septic shock, acute respiratory distress syndrome and disseminated intravascular coagulation based on his clinical course and laboratory data. After he recovered from shock, the antituberculosis chemotherapy was restarted. Intensive care resulted in the improvement of his general condition and the reduction of his chest abnormal shadows, and he was discharged 8 months after admission. No obvious recurrence was observed even after the cessation of antituberculosis chemotherapy, although pulmonary nodules on chest radiography remained.