Successful treatment by high dose glucocorticoid of miliary tuberculosis complicated with acute respiratory distress syndrome: a case report
Abstract
A 25-year-old previously healthy man presented with a productive cough for 2 months and progressive dyspnea for 1 week. He did not respond to initial anti-infective treatment at a local hospital. Chest computed tomography (CT) demonstrated diffuse miliary nodules, ground-glass opacities throughout both lungs, and bilateral pleural effusion (more prominent on the right). Laboratory tests revealed type I respiratory failure, elevated inflammatory markers, hyponatremia, hypoproteinemia, and raised tumor markers (NSE, CYFRA21-1, SCC, CA125). Sputum acid-fast bacilli smears were negative, but pleural fluid analysis showed elevated adenosine deaminase and interferon-gamma, suggestive of tuberculous pleurisy. Percutaneous lung biopsy confirmed epithelioid granulomas with positive acid-fast staining, establishing the diagnosis of miliary tuberculosis, tuberculous pleurisy, severe pulmonary infection, and acute respiratory distress syndrome (ARDS). Anti-tuberculosis therapy was withheld initially due to elevated liver enzymes and was initiated once liver function normalized. High-dose methylprednisolone (160 mg/day) combined with noninvasive positive pressure ventilation (NIPPV) was added, yielding initial improvement. However, complications arose after 8 days of NIPPV, including pneumothorax, subcutaneous and mediastinal emphysema, and suspected disseminated intravascular coagulation (DIC). NIPPV was discontinued, subcutaneous incision and xiphoid puncture drainage performed, and…
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