A rare case report of acute respiratory distress syndrome secondary to pulmonary tuberculosis: Review of radiographic findings of pulmonary tuberculosis to enhance diagnosis accuracy

Background Tuberculosis (TB) remains a global health concern, with pulmonary involvement accounting for most cases. Acute respiratory distress syndrome (ARDS) is a rare but severe complication of pulmonary TB. We report a rare case of pulmonary TB complicated by ARDS and provide a comprehensive review of characteristic chest imaging findings of pulmonary TB. Clinical presentations A previously healthy 47-year-old man, presented with acute worsening hypoxemia following 2-week fever, night sweat, productive cough, dyspnea, and weight loss. On emergency room admission, he was tachypneic (respiratory rate 30 breaths/minute, oxygen saturation 80% on room air). Sputum acid-fast bacilli smear, polymerase chain reaction (PCR) and subsequent culture confirmed Mycobacterium tuberculosis . Chest X-ray showed diffuse, reticulonodular infiltrations with multiple cavities at both upper lobes. Chest computerized tomography revealed diffuse, tree-in-bud, centrilobular nodules with areas of consolidation, consistent with active infectious tuberculosis. Despite early anti-TB regimen, the patient developed ARDS with subsequent spontaneous pneumothorax from a ruptured cavity, requiring intensive care unit admission with lung-protective ventilation, prone positioning and chest drain. After 4 weeks of mechanical ventilation and a 2-month hospital stay, he was successfully extubated and discharged without the need of supplemental oxygen. Conclusions This case highlights ARDS secondary to pulmonary TB, an uncommon and highly complicated manifestations of pulmonary TB. Recognition of clinical manifestations combined with radiographic findings including patterns and lesion distribution can facilitate a more robust diagnosis and prompt patient isolation.