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[Acute respiratory failure caused by tuberculosis].

BACKGROUND
In Poland today, tuberculosis is rarely considered as a primary cause of respiratory distress and/or multiple organ failure. We describe a case in which tuberculosis was diagnosed after admission to the ICU following three months of treatment at various health facilities.


CASE REPORT
A 13-yr-old boy was admitted to the ICU with acute respiratory distress due to a right-sided multi-focal pneumonia, pleural effusion, and mediastinitis. He also had acute renal failure and was in shock. He had been treated for three months with various antibiotics. A skin TB-test was negative, as were blood and sputum cultures. Mediastinoscopy revealed enlarged lymph nodes in the anterior and posterior mediastinum and in the right pulmonary hilus. A lymphoma was suspected and steroids were commenced.The boy was critically ill, requiring mechanical ventilation (PIP 46 cm H2O, PEEP +7), extensive inotropic support and fluid resuscitation. By using polymerase chain reaction (PCR) on material from a bronchial lavage, infection of Mycobacterium tuberculosis was revealed, and anti-TB multi drug treatment was instituted (oral pyrazinamide, ethambutol, isoniazide and iv rifampicin). The oral treatment was complicated by dysenteric diarrhea, so enteral drugs were stopped and streptomycin instituted. Intravenous isoniazide was reinstituted later because of TB-meningitis. The treatment resulted in steady improvement and the boy was discharged from the ICU after 6 weeks of treatment. Six months later he was discharged home in a satisfactory condition, without signs of neurological damage.


CONCLUSION
Tuberculosis can be very difficult to diagnose and may lead to multiple organ failure. PCR tests of specimens taken from affected body areas, should be made as early as possible.