Tuberculosis-induced acute respiratory distress syndrome treated with veno-venous extracorporeal membrane oxygenation

Abstract

Tuberculosis (TB) is a rare but known cause of acute respiratory distress syndrome (ARDS) with a high mortality. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) may be an alternative option for treating TB-induced ARDS. However, the literature on TB-induced ARDS treated with VV-ECMO is limited and the most of them were prolonged therapy. We report on a-48-year-old man with TB-induced ARDS who was successfully treated by short-term use of VV-ECMO (5 days). He was developed symptoms and hospitalized with severe dyspnea in a local hospital for 3 days before admission to our hospital. At the time when he was transferred to our hospital, his chest computed tomography showed bilateral, diffuse and consolidative shadows all over the lungs, the ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO 2 /FiO 2 ) was 50 mmHg, and respiratory system compliance was 12.5 mL/cmH 2 O. Two days after admission, Mycobacterium tuberculosis was detected by a sputum smear examination and he was diagnosed with TB-induced ARDS. VV-ECMO support was then initiated with administration of anti-TB drugs and systemic corticosteroid treatment. On the 4 th day of ECMO support, his PaO 2 /FiO 2 increased to 400 mmHg and lung compliance increased to 45 mL/cmH 2 O. He was weaned from ECMO on the 5th day of ECMO support and was extubated at the 8th day. He was discharged from hospital on the 47th hospitalized day and continued anti-TB medication at home. VV-ECMO is effective for TB-induced ARDS even in short-term administration if progression of ARDS is rapid.

Extracorporeal membrane oxygenation for tuberculosis pneumonia with empyema

“…The evidence of ECMO support in these cases is scarce and is only in the form of case reports. However, the experience had been positive, with 11/12 cases with good results [ 2 , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , 17 , 18 ], with the non-recovered patient being a case where TB was diagnosed post mortem [ 16 ]. Most of these cases used VV-ECMO, with VA-ECMO reserved for concomitant cardiologic involvement [ 15 ].…”

“…Accordingly, ECMO has been used as therapy for ARDS due to TB. However, published evidence is scarce, with only 12 cases published to our knowledge [ 2 , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] ]. We present a case of a patient with ARDS secondary to TB in whom ECMO was used as a salvage therapy in the middle of SARS-CoV-2 pandemic.…”

A new role of extracorporeal membrane oxygenation in the management of tuberculosis with acute respiratory distress syndrome: A case report and review of literature

“…[ 3 7 8 10 ] Steroids were used in four of these cases. [ 2 4 8 11 ] The mortality rate of ARDS patients with PTB has been found to be as high as 80% and above for miliary TB with ARDS. [ 1 ] ECMO could be an important treatment option for such group of patients.…”

“…[ 4 ] VV-ECMO is effective for TB-induced ARDS even in short-term administration if progression of ARDS is rapid as described by Binh et al . [ 11 ]. Similarly, in our case, our patient was put on VV-ECMO for shorter duration of time (9 days) as the progression of ARDS was rapid.…”

“…However, till date, globally, only ten cases of TB have been described, out of which six cases were of PTB patient with ARDS and four cases of miliary tuberculosis with ARDS which were subjected to ECMO. [ 2 3 4 5 6 7 8 9 10 11 ] Among the ten cases reported so far, there has been one death while recovery in other nine cases. From India, no case of PTB with ARDS subjected to ECMO has been described so far.…”