Atypical Presentation of Septic Shock: Disseminated Tuberculosis Induced Septic Shock

Abstract [asterisk][asterisk]Introduction:[asterisk][asterisk] Disseminated mycobacterium tuberculosis (M-Tb) with associated septic shock is uncommon but carries a severe prognosis. Here, we describe a case of disseminated M-TB in conjunction with septic shock. [asterisk][asterisk]Case Presentation:[asterisk][asterisk] We present the case of a 56-year-old patient with an unremarkable past medical history who was admitted to our facility due to generalized malaise. Initial evaluation revealed that he was HIV positive, with imaging showing bilateral ground-glass and micronodular opacities. During his hospital stay, the patient's condition worsened, leading to significant and progressive hypoxia. He subsequently developed severe hypotension and was transferred to the intensive care unit for more aggressive management. In the MICU, he required norepinephrine and vasopressin to maintain hemodynamic stability and was placed on mechanical ventilation due to hypoxic respiratory failure. Testing confirmed a positive acid-fast stain and M-TB PCR, while tests for Pneumocystis jirovecii and fungal infections returned negative results. An MRI of the brain with IV contrast showed leptomeningeal enhancement, but a lumbar puncture yielded negative results for tuberculosis, indicating significant disseminated tuberculosis. The patient began RIPE therapy, followed by antiretroviral treatment, which improved his hemodynamics and oxygen saturation. He was eventually transferred out of the medical intensive care unit and later discharged, with plans for ongoing follow-up care with infectious disease specialists for the management of both tuberculosis and HIV. [asterisk][asterisk]Discussion:[asterisk][asterisk] Septic shock is a severe condition associated with significant morbidity and mortality in critical illness scenarios. When septic shock arises in the context of disseminated tuberculosis, it is rare and associated with particularly high mortality rates, primarily due to delayed recognition and treatment of the illness. Disseminated TB in the pulmonary system can present similarly to other opportunistic infections in imaging studies. Thus, early suspicion, appropriate testing, and prompt treatment are crucial for optimal patient outcomes.