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Pulmonary Tuberculosis Presenting As Septic Shock in an Immunocompetent Patient: Revisiting an Old Disease With New Perspectives

Septic shock due to Mycobacterium tuberculosis (M. tuberculosis) in immunocompromised patients (particularly HIV) is a well-recognized clinical entity. However, tubercular sepsis in the immunocompetent is still underdiagnosed and under-discussed. Moreover, sepsis is usually associated with gram-nega...

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Autores principales: Malik, Manika, Lodha, Naman, Meena, Durga S, Sureka, Binit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10170580/
https://www.ncbi.nlm.nih.gov/pubmed/37182005
http://dx.doi.org/10.7759/cureus.37362
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author Malik, Manika
Lodha, Naman
Meena, Durga S
Sureka, Binit
author_facet Malik, Manika
Lodha, Naman
Meena, Durga S
Sureka, Binit
author_sort Malik, Manika
collection PubMed
description Septic shock due to Mycobacterium tuberculosis (M. tuberculosis) in immunocompromised patients (particularly HIV) is a well-recognized clinical entity. However, tubercular sepsis in the immunocompetent is still underdiagnosed and under-discussed. Moreover, sepsis is usually associated with gram-negative and other gram-positive microorganisms that can cause similar pulmonary and disseminated disease and can further convolute the diagnosis. We herein discuss a case of an elderly female who presented with acute onset fever, cough, and altered talk from the last seven days. Her initial clinical and laboratory examination revealed features of lower respiratory tract infection with septic shock. She was started on broad-spectrum antibiotics based on severe community-acquired pneumonia management guidelines. Her blood and urine cultures were sterile. She did not respond to initial antibiotics. Furthermore, sputum production was not possible, which compelled us for gastric aspirate analysis, which came positive for cartridge-based nucleic acid amplification test (CBNAAT). In repeated blood cultures, M. tuberculosis was also isolated. She was started on antitubercular treatment; on the 12th day of antitubercular treatment, she developed acute respiratory distress and eventually succumbed to her illness on the 19th day of hospitalization. We highlighted the importance of early diagnosis and prompt antitubercular therapy in tubercular septic shock. We also discuss the possibility of tubercular-immune reconstitution inflammatory syndrome (IRIS) in such patients, which could be a contributing factor to mortality.
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spelling pubmed-101705802023-05-11 Pulmonary Tuberculosis Presenting As Septic Shock in an Immunocompetent Patient: Revisiting an Old Disease With New Perspectives Malik, Manika Lodha, Naman Meena, Durga S Sureka, Binit Cureus Internal Medicine Septic shock due to Mycobacterium tuberculosis (M. tuberculosis) in immunocompromised patients (particularly HIV) is a well-recognized clinical entity. However, tubercular sepsis in the immunocompetent is still underdiagnosed and under-discussed. Moreover, sepsis is usually associated with gram-negative and other gram-positive microorganisms that can cause similar pulmonary and disseminated disease and can further convolute the diagnosis. We herein discuss a case of an elderly female who presented with acute onset fever, cough, and altered talk from the last seven days. Her initial clinical and laboratory examination revealed features of lower respiratory tract infection with septic shock. She was started on broad-spectrum antibiotics based on severe community-acquired pneumonia management guidelines. Her blood and urine cultures were sterile. She did not respond to initial antibiotics. Furthermore, sputum production was not possible, which compelled us for gastric aspirate analysis, which came positive for cartridge-based nucleic acid amplification test (CBNAAT). In repeated blood cultures, M. tuberculosis was also isolated. She was started on antitubercular treatment; on the 12th day of antitubercular treatment, she developed acute respiratory distress and eventually succumbed to her illness on the 19th day of hospitalization. We highlighted the importance of early diagnosis and prompt antitubercular therapy in tubercular septic shock. We also discuss the possibility of tubercular-immune reconstitution inflammatory syndrome (IRIS) in such patients, which could be a contributing factor to mortality. Cureus 2023-04-10 /pmc/articles/PMC10170580/ /pubmed/37182005 http://dx.doi.org/10.7759/cureus.37362 Text en Copyright © 2023, Malik et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Internal Medicine
Malik, Manika
Lodha, Naman
Meena, Durga S
Sureka, Binit
Pulmonary Tuberculosis Presenting As Septic Shock in an Immunocompetent Patient: Revisiting an Old Disease With New Perspectives
title Pulmonary Tuberculosis Presenting As Septic Shock in an Immunocompetent Patient: Revisiting an Old Disease With New Perspectives
title_full Pulmonary Tuberculosis Presenting As Septic Shock in an Immunocompetent Patient: Revisiting an Old Disease With New Perspectives
title_fullStr Pulmonary Tuberculosis Presenting As Septic Shock in an Immunocompetent Patient: Revisiting an Old Disease With New Perspectives
title_full_unstemmed Pulmonary Tuberculosis Presenting As Septic Shock in an Immunocompetent Patient: Revisiting an Old Disease With New Perspectives
title_short Pulmonary Tuberculosis Presenting As Septic Shock in an Immunocompetent Patient: Revisiting an Old Disease With New Perspectives
title_sort pulmonary tuberculosis presenting as septic shock in an immunocompetent patient: revisiting an old disease with new perspectives
topic Internal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10170580/
https://www.ncbi.nlm.nih.gov/pubmed/37182005
http://dx.doi.org/10.7759/cureus.37362
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