Extracorporeal blood purification benefits in post-caesarean patient with severe acute respiratory distress syndrome due to miliary tuberculosis: a case report

• Published in: Journal of medical case reports Vol. 17; no. 1; p. 157
• Main Authors: Zakaria, Gumarbio Setiadi, Taufik, Muhammad Azhari, Manggala, Sidharta Kusuma, Jennefer
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 12.04.2023; BioMed Central; BMC
• Subjects: Acute respiratory distress syndrome; Adult; Antibiotics; Bacterial infections; BCG; BCG vaccines; Biological response modifiers; Blood pressure; Blood purification; Body temperature; C-reactive protein; Case Report; Case reports; Cesarean section; Cesarean Section - adverse effects; Continuous veno-venous hemofiltration; Cytokines; Disease transmission; Female; Health aspects; Heart rate; Hemodynamics; Hepatitis; HIV; Human immunodeficiency virus; Humans; Infections; Interferon; Interleukins; Laboratories; Miliary tuberculosis; Mortality; Mycobacterium tuberculosis; Pneumonia; Pregnancy; Respiratory distress syndrome; Respiratory Distress Syndrome - etiology; Sepsis; Septic shock; Severe acute respiratory syndrome coronavirus 2; Shock, Septic - complications; Surgery; Tuberculosis; Tuberculosis, Miliary - complications; United Kingdom; X-rays; United Kingdom; Indonesia; Blood purification; Continuous veno-venous hemofiltration; Miliary tuberculosis
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-023-03853-w

Miliary tuberculosis is a life-threatening disease caused by the hematogenous spread of Mycobacterium tuberculosis. It is uncommon in pregnancy. Mortality rates for patients with miliary tuberculosis who require mechanical ventilation are high (60-70%). We reported a rare and challenging case, a 35-year-old Asian woman with 34 weeks of pregnancy, and miliary tuberculosis with acute respiratory distress syndrome and septic shock. The patient presented with severe acute respiratory distress syndrome, necessitating mechanical ventilation, vasopressor, and pregnancy termination with caesarean section. The patient underwent blood purification with continuous veno-venous hemofiltration using an oXiris filter for 24 hours. After continuous veno-venous hemofiltration, the patient's condition was greatly improved, and the patient was successfully extubated and was able to breathe spontaneously without vasopressor on the third day. High levels of interleukin-6, interleukin-10, procalcitonin, C-reactive protein, interferon-γ, and tumor necrosis factor-α were found postoperatively. The bacterial infection of tuberculosis, acute respiratory distress syndrome, and the stress response from the caesarean section contributed to the high levels of cytokines, which correlated with the patient's severe inflammatory condition. The cytokine levels were greatly reduced after the blood purification procedure and this might be associated with the patient's clinical improvement. Extracorporeal blood purification could help to disrupt the vicious cycle of inflammation.