Pulmonary Tuberculosis-Related Acute Respiratory Distress Syndrome in a Healthy Adult Rescued by Extracorporeal Membrane Oxygenation- A Case Report and Literature Review

健康成人罹患肺結核所導致之急性呼吸窘迫症候群以葉克膜治療－病例報告與文獻回顧

陳政昕(Cheng-Hsin Chen) ； 高國晉(Kuo-Chin Kao) ； 陳濘宏(Ning-Hung Chen) ； 黃崇旂(Chung-Chi Huang) ； 林恆毅(Hen-I Lin) ； 張炎德(Yen-The Chang) ； 胡漢忠(Han-Chung Hu)

《胸腔醫學》 31卷1期 (2016/02) Pp. 60-66

摘要

結核病是台灣最重要的感染性疾病之一，其病程通常為慢性而漸進式的，由肺結核所導致的急性呼吸窘迫症候群相當罕見。本個案報告為一位36歲原先健康情況良好的女性病患，罹患急性呼吸窘迫症候群，痰液抗酸性染色及培養證實為肺結核所致，且並無其他致病菌病因被發現。雖然已給予抗結核藥物治療，但在傳統呼吸器支持下動脈血中氧氣分壓仍持續嚴重低下，因此給予靜脈－靜脈模式機械性體外循環維生系統支持。在積極治療之下，病情仍逐漸惡化，最終病患因敗血性休克及多重器官衰竭而死亡。這篇個案報告顯示，在急性呼吸窘迫症候群的鑑別診斷中，肺結核也是不可忽略的病因之一，尤其是在流行地區的台灣。

關鍵字

肺結核 ； 急性呼吸窘迫症候群 ； 機械性體外循環維生系統

並列摘要

Pulmonary tuberculosis (TB) has rarely been recognized as an etiologic agent of acute respiratory distress syndrome (ARDS). In this case report, we describe a previously healthy 36-year-old female who developed severe ARDS caused by pulmonary TB. Pulmonary TB was confirmed by positive acid-fast stain and TB sputum culture results; other microbiological etiologies showed negative findings. In addition to treatment with anti-TB agents, veno-venous mode extracorporeal membrane oxygenation was performed owing to progressive severe oxygenation failure under conventional mechanical ventilation. Despite aggressive treatment in the intensive care unit, the patient's condition deteriorated and she died as a result ofseptic shock and multiple organ failure. This case report demonstrated that pulmonary TB should not be ignored as a possible cause of ARDS, in order to avoid the adverse consequences of delayed diagnosis or missed treatment, especially in an endemic area.

並列關鍵字

pulmonary tuberculosis ； acute respiratory distress syndrome ； extracorporeal membrane