PULMONARY TB WITH HUMAN PARAINFLUENZA 3 VIRUS PRESENTING AS SEPTIC SHOCK WITH MULTIORGAN SYSTEM FAILURE

Abstract

SESSION TITLE: Critical Care Presentations of TBSESSION TYPE: Rapid Fire Case ReportsPRESENTED ON: 10/18/2022 12:25 pm - 01:25 pmINTRODUCTION: Septic shock with Multiple Organ System Failure (MOSF) from Mycobacterium tuberculosis (MTB) is an uncommon, yet well-known clinical syndrome with high rate of in-hospital mortality (79.2%). Most Human Parainfluenza Virus (HPIV) in immunocompetent adults are mild or asymptomatic. However, not much is known about MTB co-infection with HPIV causing septic shock with MOSF. To the best of our knowledge, this is the first case of pulmonary MTB with HPIV infection presenting as septic shock with multiorgan failure reported in literature.CASE PRESENTATION: Patient is a 72 yo Spanish speaking male without significant past medical history, visiting from Mexico, who presented to the ED with cough. He was at baseline health until the day prior to the presentation when he noted cough with streaked hemoptysis, nausea, vomiting with fever. While in the ED, patient developed respiratory distress with hypotension, needing intubation, mechanical ventilation and vasopressors. CT of the chest demonstrated extensive right middle and lower lung consolidation, concerning for pneumonia. Respiratory pathogen panel was positive for HPIV, type 3. Pt developed multiorgan failure including renal failure needing CVVH, biventricular heart failure with EF of 15% and shock liver. Sputum culture was positive for MTB. Pt was started on anti-TB treatment with ethambutol, isoniazid, pyrazinamide, and rifampin. He clinically improved and after 2-week course of hospitalization was discharged home with outpatient follow up with Health Department and Infectious disease.DISCUSSION: Septic shock with multiorgan failure from MTB is rare yet known phenomenon with high rate of in-hospital mortality, however, co-infection of MTB with parainfluenza virus is not well described. The role of HPIV infection in causing respiratory tract illness is likely contributing factor making pulmonary MTB infection more complicated that can lead to septic shock with multiorgan failure.CONCLUSIONS: Pulmonary MTB co-infection with HPIV can present with septic shock with multiorgan failure. Further studies are needed to investigate and support significance of HPIV to pulmonary MTB.Reference #1: https://pubmed.ncbi.nlm.nih.gov/23429859/Reference #2: https://pubmed.ncbi.nlm.nih.gov/28283855/DISCLOSURES: No relevant relationships by Dovile BaniulisNo relevant relationships by Dovile CerkauskaiteNo relevant relationships by Momcilo Durdevic SESSION TITLE: Critical Care Presentations of TB SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Septic shock with Multiple Organ System Failure (MOSF) from Mycobacterium tuberculosis (MTB) is an uncommon, yet well-known clinical syndrome with high rate of in-hospital mortality (79.2%). Most Human Parainfluenza Virus (HPIV) in immunocompetent adults are mild or asymptomatic. However, not much is known about MTB co-infection with HPIV causing septic shock with MOSF. To the best of our knowledge, this is the first case of pulmonary MTB with HPIV infection presenting as septic shock with multiorgan failure reported in literature. CASE PRESENTATION: Patient is a 72 yo Spanish speaking male without significant past medical history, visiting from Mexico, who presented to the ED with cough. He was at baseline health until the day prior to the presentation when he noted cough with streaked hemoptysis, nausea, vomiting with fever. While in the ED, patient developed respiratory distress with hypotension, needing intubation, mechanical ventilation and vasopressors. CT of the chest demonstrated extensive right middle and lower lung consolidation, concerning for pneumonia. Respiratory pathogen panel was positive for HPIV, type 3. Pt developed multiorgan failure including renal failure needing CVVH, biventricular heart failure with EF of 15% and shock liver. Sputum culture was positive for MTB. Pt was started on anti-TB treatment with ethambutol, isoniazid, pyrazinamide, and rifampin. He clinically improved and after 2-week course of hospitalization was discharged home with outpatient follow up with Health Department and Infectious disease. DISCUSSION: Septic shock with multiorgan failure from MTB is rare yet known phenomenon with high rate of in-hospital mortality, however, co-infection of MTB with parainfluenza virus is not well described. The role of HPIV infection in causing respiratory tract illness is likely contributing factor making pulmonary MTB infection more complicated that can lead to septic shock with multiorgan failure. CONCLUSIONS: Pulmonary MTB co-infection with HPIV can present with septic shock with multiorgan failure. Further studies are needed to investigate and support significance of HPIV to pulmonary MTB. Reference #1: https://pubmed.ncbi.nlm.nih.gov/23429859/ Reference #2: https://pubmed.ncbi.nlm.nih.gov/28283855/ DISCLOSURES: No relevant relationships by Dovile Baniulis No relevant relationships by Dovile Cerkauskaite No relevant relationships by Momcilo Durdevic