Peck-Radosavljevic M, Prokesch R, Schmid K, Frossard M, Wichlas M, Gendo A, Gangl A, Madl C
Department of Gastroenterology and Hepatology, Intensive Care Unit, Vienna, Austria.
Wien Klin Wochenschr. 1999 Feb 26;111(4):157-60.
We report the case of a 42 years old, non-immunocompromised native Austrian living in Vienna. He presented at home with severe dyspnea and had to be intubated immediately. Shortly after hospital admission, he developed severe adult respiratory distress syndrome (ARDS) and septic shock with massive, bilobar patchy to confluent infiltrations and a need for norepinephrine. A CT-scan revealed severe loss of functional lung tissue with areas of consolidation and multiple communicating cystic spaces. Air leaking into the mediastinum through fistulas produced pneumomediastinum, pneumoperitoneum, and a massive soft tissue emphysema. Bronchoalveolar lavage performed within the first 24 hours of admission revealed + of acid-fast bacilli. Even though appropriate tuberculostatic medication was started immediately, the patient succumbed the next day to ARDS due to massive tuberculous pneumonia and miliary disease (Sepsis tuberculosis gravissima).
我们报告了一名42岁、非免疫功能低下的奥地利本地人，居住在维也纳。他在家中出现严重呼吸困难，必须立即插管。入院后不久，他发展为严重的成人呼吸窘迫综合征（ARDS）和感染性休克，伴有双侧大片状至融合性浸润，且需要去甲肾上腺素治疗。CT扫描显示功能性肺组织严重丧失，伴有实变区域和多个相互连通的囊性空间。空气通过瘘管漏入纵隔，导致纵隔气肿、气腹和大量软组织气肿。入院后24小时内进行的支气管肺泡灌洗显示抗酸杆菌阳性。尽管立即开始了适当的抗结核药物治疗，但患者次日因严重的结核性肺炎和粟粒性疾病（严重脓毒症性结核病）死于ARDS。
