A70-46 Tuberculosis-Associated Acute Respiratory Distress Syndrome (ARDS) in an HIV-Negative Patient: A Rapid and Fatal Course

Abstract Tuberculosis (TB) is an uncommon cause of acute respiratory distress syndrome (ARDS), accounting for 1-5% of pulmonary TB cases, with mortality rates exceeding 50-70%, most often in immunocompromised hosts. We report a case of a 40-year-old HIV-negative Puerto Rican woman with a history of crack cocaine and heavy alcohol use who presented with two months of fatigue, dizziness, productive cough, and significant weight loss. On admission, she was cachectic with severe microcytic hypochromic anemia, marked lymphopenia, and hypoalbuminemia. Chest computed tomography revealed bilateral consolidations, a left upper-lobe cavitation, and right-sided tree-in-bud opacities. She was admitted under airborne precautions and started on empiric antibiotics for community-acquired and opportunistic pneumonia. By the third hospital day, she developed severe hypoxemia meeting Berlin criteria for ARDS, requiring intubation, lung-protective ventilation, and prone positioning with transient improvement in oxygenation. Induced sputum nucleic acid amplification testing confirmed Mycobacterium tuberculosis, and four-drug antituberculous therapy was initiated. Despite aggressive intensive care management, her course was complicated by septic shock requiring vasopressors, refractory hypoxemia, and multi-organ failure, resulting in death on day 16 of hospitalization. This case highlights the aggressive course and high mortality of TB-associated ARDS (TB-ARDS) even in immunocompetent, HIV-negative patients. It underscores the importance of early recognition and consideration of TB in patients presenting with ARDS and CT findings suggestive of TB, particularly in high-risk populations. Prompt diagnosis and initiation of therapy remain crucial, yet outcomes are often poor despite timely treatment and advanced supportive care. This abstract is funded by: None