A70-05 A Case of Acute Tuberculosis Pneumonia

Abstract Pulmonary tuberculosis (PTB) has a high prevalence in Latin America, usually PTB presents with chronic symptoms and upper opacities including cavitations, but in some cases it can be manifested with acute symptoms and radiologic infiltrates mimicking CAP as in this case. A 40-year-old man was hospitalized in the emergency room for cough and shortness of breath of two weeks of duration. The cough was intermittent, productive, associated with low-grade fever and night sweats. He works for the police department, his medical and family history showed no relation to TB or other lung diseases, no history of smoking, vaping, drugs. He drinks alcohol regularly on weekends. No history of hypertension, diabetes and Elisa test for HIV was negative. On examination, he was conscious, normal blood pressure, tachycardic and tachypneic. SpO2 85% on room air. Respiratory auscultation revealed no abnormal sounds, cardiovascular and other systems were unremarkable. Initial chest X-ray (CXR) revealed consolidations over left upper, middle and lower fields. Chest CT showed a combination of alveolar consolidations and solid centrilobular nodules in upper, middle and lower lobes, no cavitation lesions were seen. A diagnosis of Community Acquired Pneumonia (CAP) was made and started on IV antibiotics, ceftriaxone plus azythromycin and nasal oxygen. Absolut white blood cells (WBC) were normal (9.6 x 103/uL), neutrophils count 7.3 x 103/uL, lymphocytes 1.3 x 103/ul, monocytes 0.8 x 103/uL, eosinophils 0.1 x 103/uL, RBC with hemoglobin 11.2 gr/dl, hematocrit 32.7%, platelets 508 x 103/uL. PCR 129 mg/dl, procalcitonin (PCT) 0.095 ng/ml, and normal blood chemistry and renal function, creatinine 0.9 mg/dl, sodium 135 mmol/L, potassium 3.45 mmol/L, chloride 103 mmol/L, plasma glucose 97 mg/dl. 48 hours after admission the patient was intubated due to respiratory failure and hypoxemia and was admitted to ICU. Sputum culture for bacteria was negative, COVID 19 and influenza virus rapid tests were negative. A sputum sample for Xprt MTB assay culture was ordered and confirmed positive for Mycobacterial tuberculosis with negative RIF resistance. Oral anti TB treatment was initiated via nasogastric tube, he continued on mechanical ventilation for two weeks and was successfully extubated, with clinical and radiologic improvement. This is a very rare form of Tuberculosis and is associated with immunosuppressed conditions. The acute presentation can result from primary infection, progressive primary disease or reactivation of latent TB. The delay in diagnosis and treatment in this form of disease can be fatal. This abstract is funded by: None