A CASE OF MILIARY TUBERCULOSIS SHOWING ACUTE RESPIRATORY FAILURE DURING PREGNANCY

Abstract

A case of miliary tuberculosis showing acute respiratory failure during pregnancy was reported.
A 26-year-old, eight months pregnant woman, was admitted to our hospital with a nonproductive coughand fever.
On admission, she was severely ill with dyspnea at rest, her temperature was 38.7°, pulse 132/min, respiratory rate 66/min and blood pressure 124/84mm Hg. Examination revealed basilar raleson both sides and an enlarged uterus consistent with an eight-month-pregnancy. A chest X-ray showed a diffuse miliary infiltrate scattered throughout whole lung especially in both lower lung fields witha partially confluent pattern. Laboratory examination revealed accelerated ESR, positive CRP, and increased 2-globulin. The PPD skin test was negative. Arterial blood gas level of the patientbreathing room air was as follows: P₂CO₂ 48.5 TORR, P₂CO₂ 29.3 TORR, pH 7.42. Initial smearsof sputum for acid fast bacilli were negative.
An ophthalmoscopic examination disclosed the presence of choroidal tubercles, and a bone marrowaspiration showed giant celled caseating granuloma, which was of great value in establishing diagnosisof miliary tuberculosis.Intensive therapy with anti-tuberculosis drugs (Isoniazid, 400mg, Rifampicin, 750mg, and Streptomycin, 1g daily) was started supplemented with the use of diuretics, aminophilline, digitalis, and O2. Corticosteroids were administered, which appeared to be effective in reducing systemic toxicity and faster roentgenographic resolution. Recovery from hypoxemia steadily continued.
The patient gave birth to a baby on June 23 and the baby had no signs of tuberculosis.
This case report emphasizes the fact that miliary tuberculosis may present an acute respiratoryfailure symptom which may respond rapidly to a treatment with early and intensive use of anti-tuberculosis drugs and, in some case, corticosteroids.