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.
10.4266/kjccm.2013.28.2.108
- Author:
Su Jin LIM
1
;
Donghoon LEW
;
Haa Na SONG
;
You Eun KIM
;
Seung Jun LEE
;
Yu Ji CHO
;
Yi Yeong JEONG
;
Mi Jung PARK
;
Kyoung Nyeo JEON
;
Ho Cheol KIM
;
Jong Deog LEE
;
Young Sil HWANG
Author Information
1. Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea. hochkim@gnu.ac.kr
- Publication Type:Original Article
- Keywords:
anti-tuberculosis treatment;
pumonary tuberculosis;
respiratory failure
- MeSH:
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
- From:The Korean Journal of Critical Care Medicine
2013;28(2):108-114
- CountryRepublic of Korea
- Language:Korean
-
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.
