Severe Inflammatory Response and Moderate Acute Respiratory Distress Syndrome (ARDS) in an Immunocompetent Patient With Disseminated Tuberculosis: A Case Report.
- 1Faculty of Medicine, Ain Shams University, Cairo, EGY.
- 2Internal Medicine, Broward Health North, Deerfeild Beach, USA.
- 3Infectious Disease, Broward Health North, Deerfeild Beach, USA.
Abstract
An acute exacerbation in some tuberculosis (TB) cases can lead to widespread infection; this disseminated disease may progress when the body's immune response becomes dysregulated. Although rare, certain patients without obvious immune compromise can develop severe organ dysfunction if inflammation escalates uncontrollably. Respiratory failure can develop rapidly once lung tissue becomes overwhelmed by excessive inflammatory signaling. This presentation is uncommon but severe and is frequently unrecognized in its early stages because symptoms mimic other critical conditions. Mortality increases substantially once acute respiratory distress syndrome (ARDS) develops in the setting of disseminated infection. A 40-year-old man, previously in good health, presented with severe respiratory distress. Oxygen saturation declined rapidly, requiring urgent endotracheal intubation. He subsequently required vasopressor support and prone positioning due to advanced respiratory failure. Laboratory evaluation revealed thrombocytopenia and elevated liver enzymes. Comprehensive microbiological testing did not identify common viral, bacterial, or fungal pathogens. A positive Mycobacterium tuberculosis (MTB) PCR result from bronchial fluid confirmed disseminated TB. His clinical course was complicated by moderate ARDS and a hyperinflammatory state, consistent with an exaggerated immune response to TB. Treatment was initiated with rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) therapy along with systemic corticosteroids (methylprednisolone 40 mg every eight hours). Clinical improvement was observed, and ventilatory support was discontinued following targeted treatment. The patient was discharged with a plan for prolonged anti-tubercular therapy. This case illustrates how disseminated TB can trigger a severe inflammatory response leading to moderate ARDS, even in the absence of underlying immunosuppression. Early recognition of this presentation is critical, and combined treatment with antimicrobial therapy and immunomodulation may improve outcomes.
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BibTeX
@article{zeizzoun2026severe,
title = {{Severe Inflammatory Response and Moderate Acute Respiratory Distress Syndrome (ARDS) in an Immunocompetent Patient With Disseminated Tuberculosis: A Case Report.}},
author = {Rawan Zeizzoun and Linnet Leon Chaviano and Amer Zeizoun and Mahesh Kumar},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116708},
url = {https://europepmc.org/article/MED/42923834},
note = {CC BY},
}
RIS
TY - JOUR
TI - Severe Inflammatory Response and Moderate Acute Respiratory Distress Syndrome (ARDS) in an Immunocompetent Patient With Disseminated Tuberculosis: A Case Report.
AU - Rawan Zeizzoun
AU - Linnet Leon Chaviano
AU - Amer Zeizoun
AU - Mahesh Kumar
PY - 2026
DA - 2026/09/22
JO - Cureus
DO - 10.7759/cureus.116708
UR - https://europepmc.org/article/MED/42923834
AB - An acute exacerbation in some tuberculosis (TB) cases can lead to widespread infection; this disseminated disease may progress when the body's immune response becomes dysregulated. Although rare, certain patients without obvious immune compromise can develop severe organ dysfunction if inflammation escalates uncontrollably. Respiratory failure can develop rapidly once lung tissue becomes overwhelmed by excessive inflammatory signaling. This presentation is uncommon but severe and is frequently unrecognized in its early stages because symptoms mimic other critical conditions. Mortality increases substantially once acute respiratory distress syndrome (ARDS) develops in the setting of disseminated infection. A 40-year-old man, previously in good health, presented with severe respiratory distress. Oxygen saturation declined rapidly, requiring urgent endotracheal intubation. He subsequently required vasopressor support and prone positioning due to advanced respiratory failure. Laboratory evaluation revealed thrombocytopenia and elevated liver enzymes. Comprehensive microbiological testing did not identify common viral, bacterial, or fungal pathogens. A positive Mycobacterium tuberculosis (MTB) PCR result from bronchial fluid confirmed disseminated TB. His clinical course was complicated by moderate ARDS and a hyperinflammatory state, consistent with an exaggerated immune response to TB. Treatment was initiated with rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) therapy along with systemic corticosteroids (methylprednisolone 40 mg every eight hours). Clinical improvement was observed, and ventilatory support was discontinued following targeted treatment. The patient was discharged with a plan for prolonged anti-tubercular therapy. This case illustrates how disseminated TB can trigger a severe inflammatory response leading to moderate ARDS, even in the absence of underlying immunosuppression. Early recognition of this presentation is critical, and combined treatment with antimicrobial therapy and immunomodulation may improve outcomes.
SN - 2168-8184
ER -