A case of miliary tuberculosis associated with ARDS, DIC and bilateral pneumothorax

Abstract

We reported a case of 64 a year-old male patient of miliary tuberculosis associated with ARDS, DIC and pneumothorax, who had a history of gastric ulcer and pulmonary tuberculosis. On admission his chief complaints were fever, fatigue, palpitation, appetite loss and weight loss, and most noticeable abnormalities were bleeding from the gastric ulcer and miliary shadow on the chest x-ray film with hypoxemia. On the day after admission to the hospital he was diagnosed as ARDS as he showed severe hypoxemia due to extensive tuberculous infiltration in bilateral lung fields, and treatment with antituberculous drugs and steroids were started. On the third hospital day DIC appeared on laboratory data, Gabexate mesilate (FOY) for DIC and respirator for ARDS were introduced. Two weeks later pulmonary infiltration, PaO2 and general condition were somewhat improved. On the 15th day after admission pneumothorax occurred on the right side, and on the 20th day on the left. Tube drainage of both pleural cavities, and instillation of OK-432 and Fibrinogen HT into the right pleural cavity were done, but it showed no effect. Two months after admission pouring Fibrinogen HT and thrombin into the left B1+2 and right B1 with cannula washing pipe through the instrument channel of bronchoscope was carried out. A few days later air leakage stopped and collapsed lungs were completely expanded. This method is effective in the case of incurable pneumothorax with pulmonary hypofunction.