Korean J Crit Care Med.  2013 May;28(2):108-114. 10.4266/kjccm.2013.28.2.108.

Development of Acute Respiratory Failure on Initiation of Anti-Tuberculosis Medication in Patients with Pulmonary Tuberculosis: Clinical and Radiologic Features of 8 Patients and Literature Review

• Lim SJ
• Lew D
• Song HN
• Kim YE
• Lee SJ
• Cho YJ
• Jeong YY
• Park MJ
• Jeon KN
• Kim HC
• Lee JD
• Hwang YS

• KMID: 2227855
• DOI: http://doi.org/10.4266/kjccm.2013.28.2.108

Abstract

BACKGROUND
Acute respiratory failure can occur paradoxically on initiation of anti-tuberculosis (TB) treatment in patients with pulmonary TB. This study is aimed to analyze the clinical features of anti-TB treatment induced acute respiratory failure.
METHODS
We reviewed the clinical and radiological characteristics of 8 patients with pulmonary tuberculosis (5 men and 3 women; mean age, 55 +/- 15.5 years) who developed acute respiratory failure following initiation of anti-TB medication and thus required mechanical ventilation (MV) in the intensive care unit (ICU).
RESULTS
The interval between initiation of anti-TB medication and development of MV-requiring acute respiratory failure was 2-14 days (mean, 4.4 +/- 4.39 days), and the duration of MV was 1-18 days (mean, 7.1 +/- 7.03 days). At admission, body temperature and serum levels of lactate dehydrogenase and C-reactive protein were increased. Serum levels of protein, albumin and creatinine were 5.8 +/- 0.98, 2.3 +/- 0.5 and 1.8 +/- 2.58 mg/ml, respectively. Radiographs characterized both lung involvements in all patients. Consolidation with the associated nodule was noted in 7 patients, ground glass opacity in 2, and cavitary lesion in 4. Micronodular lesion in the lungs, suggesting miliary tuberculosis lesion, was noted in 1 patient. At ICU admissions, the ranges of the APACHE II and SOFA scores were 17-38 (mean, 28.2 +/- 7.26) and 6-14 (mean, 10.1 +/- 2.74). The mean lung injury score was 2.8 +/- 0.5. Overall, 6 patients died owing to septic shock and multiorgan failure.
CONCLUSIONS
On initiation of treatment for pulmonary TB, acute respiratory failure can paradoxically occur in patients with extensive lung parenchymal involvement and high mortality.

Keyword

anti-tuberculosis treatment; pumonary tuberculosis; respiratory failure

MeSH Terms

APACHE
Body Temperature
C-Reactive Protein
Creatinine
Glass
Humans
Intensive Care Units
L-Lactate Dehydrogenase
Lung
Lung Injury
Male
Respiration, Artificial
Respiratory Insufficiency
Shock, Septic
Tuberculosis, Miliary
Tuberculosis, Pulmonary
C-Reactive Protein
Creatinine
L-Lactate Dehydrogenase