Published online Sep 11, 2019. doi: 10.5492/wjccm.v8.i5.72
Peer-review started: April 8, 2019
First decision: August 2, 2019
Revised: August 13, 2019
Accepted: August 21, 2019
Article in press: August 21, 2019
Published online: September 11, 2019
Tuberculosis (TB) is a rare etiology of the septic shock. Timely administration of the anti-microbial agents has shown mortality benefit. Prompt diagnosis and a high index of suspicion are crucial to the management. We present three cases of TBSS with poor outcome in the majority despite timely and susceptible antibiotic administration.
Sixty-seven-year-old woman with latent TB presented with fever, cough, and shortness of breath. She was promptly diagnosed with active TB and started on the appropriate anti-microbial regimen; she had a worsening clinical course with septic shock and multi-organ failure after initiation of antibiotics. Thirty-three-year-old man immunocompromised with acquired immune deficiency syndrome presented with fever, anorexia and weight loss. He had no respiratory symptoms, and first chest X-ray was normal. He had enlarged liver, spleen and lymph nodes suspicious for lymphoma. Despite broad-spectrum antibiotics, he succumbed to refractory septic shock and multi-organ failure. It was shortly before his death that anti-TB antimicrobials were initiated based on pathology reports of bone marrow and lymph node biopsies. Forty-nine-year-old woman with asthma and latent TB admitted with cough and shortness of breath. Although Initial sputum analysis was negative, a subsequent broncho-alveolar lavage turned out to be positive for acid fast bacilli followed by initiation of susceptible ant-TB regimen. She had a downward spiral clinical course with shock, multi-organ failure and finally death.
Worse outcome despite timely initiation of appropriate antibiotics raises suspicion of TB immune reconstitution as a possible pathogenesis for TB septic shock.
Core tip: Tuberculosis septic shock is a rare entity. We present three cases of tuberculosis septic shock with varied clinical manifestations. Mycobacterium tuberculosis culture or nucleic acid amplification testing confirmed diagnosis of tuberculosis. All of our presented cases had poor outcome despite timely administration of appropriate anti-tuberculosis regimen. There was clinical and radiological deterioration after administration of anti-microbial agents. This deteriorating clinical course raises a concern for immune reconstitution as possible pathogenesis for tuberculosis septic shock.