A case of miliary tuberculosis with tuberculous meningitis in intensive care

摘要

Tuberculosis (TB) is one of the commonest causes of death due to infection worldwide. Miliary tuberculosis (MTB) is very rare in the intensive care unit (ICU) and carries a significant risk of death. This case report describes the presentation and management issues of MTB along with TB meningitis in ICU.Case reportA 42-year-old Afro-Caribbean lady presented to the hospital with a two-month history of non-productive cough, shortness of breath and generally feeling unwell with progressive deterioration. Chest X-ray revealed bilateral interstitial shadowing. Bronchial washings were positive for mycobacterium tuberculosis confirming the diagnosis of MTB. Blood results revealed anaemia and deranged liver function. An abdominal ultrasound sc.an demonstrated multiple liver abscesses consistent with TB of the liver. She developed severe respiratory failure necessitating mechanical ventilation on ICU. She was commenced on four drug anti-tuberculosis therapy (ATT).During her long stay in ICU repeated attempts to wean her off the ventilator failed due to worsening respiratory failure. Even attempts to wean her off sedation failed due to increased agitation. She failed to absorb enteral feed, which meant her ATT had to be given parenterally. On day 50 on ICU, due to increasing agitation, a CT of her head was performed. This demonstrated a low density lesion with generalised meningeal enhancement,