SEVERE RESPIRATORY FAILURE WITH PULUMONARY TUBERCULOSIS DURING INITIAL PHASE OF CHEMOTHERAPY

Abstract

In seven patients with tuberculosis required ventilatory assistance, in our IRCU at the Habikino Hospital, we found worsening of the findings on chest X-ray film and clinicalstatus during initial phase of chemotherapy, although their sputum became negative foracid-fast bacilli. On admission, six of them had large infiltration with cavities and discharged a large number of bacilli with elevation of ESR and hypoalbuminemia. We could get four patents off ventirator after start of PEEP therapy and high dosecorcicosteroid therapy. But three of them died at last, because they developed severerespiratory failure again. Pulmonary histology was available in five patients. We foundinterstitial and intra-alveolar pulmonary edema, intra-alveolar organization, hyperplasiaof alveolar wall, and hyaline membrane formation. These findings were compatible withdiffuse alveolar dammage.