Abstract
A 51-year-old woman was transferred to the intensive care unit with such symptoms as fever, swollen left knee joint, pain and hypotension. After preliminary evaluation, she was diagnosed as suffering acute suppurative arthritis and septic shock. Then, she was rescued and prescribed to receive treatment with broad-spectrum antibiotics. However, there was no source of infection identified except for the knee joint. The bacterial and fungal cultures of blood samples and articular effusion were shown to be negative, while the results obtained from the next-generation sequencing of blood and articular effusion revealed that Mycobacterium tuberculosis was positive. The patient was then put on five combinations of anti-tuberculosis therapeutic treatment. Nevertheless, despite the active anti-tuberculosis treatment put in place, her general condition still deteriorated progressively. As the level of her bilirubin continued to rise, further treatment was affected, which prompted the change made to the anti-tuberculosis treatment program. Her clinical condition continued to deteriorate, which led to the development of unstable vital signs and the multiple organ dysfunction syndrome. In spite of our best efforts to save her life, the patient still ended up with death.
Highlights
Anti-synthetase syndrome (ASS) is referred to as a clinical classification of idiopathic inflammatory myopathy, which is mainly treated with hormones and immunosuppressants [1]
A dermatomyositis patient is reported who got admitted to the intensive care unit because of various clinical symptoms including knee joint redness, swelling, heat and pain, high fever, septic shock and multiple organ failure
There have been a large number of studies substantiating that the tuberculosis sepsis patients needing intensive care unit (ICU) treatment are at increased risk of in-hospital mortality [9,10,11]
Summary
Anti-synthetase syndrome (ASS) is referred to as a clinical classification of idiopathic inflammatory myopathy, which is mainly treated with hormones and immunosuppressants [1]. Considering that the patient had negative culture multiple times in the previous month, the NGS examination was conducted for joint cavity pus and blood samples at the same time. After about 10 days of anti-tuberculosis treatment, the body temperature improved, the ST segment of ECG decreased, myocardial enzymes returned to normal, shock was alleviated, and the count of platelets increased. Five days after the adjustment made to anti-tuberculosis drugs, the patients showed such tuberculosis poisoning symptoms as high fever and shock, norepinephrine of 1.2 ug/kg/kg·min, which was accompanied by a decline in the count of platelet again. Afterwards, both liver function and cardiac function further deteriorated. Our advice against further treatment was rejected by her family members
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