Marsepoil T, Griguere P, Mahassini B, Levesque P, Blin F
Service de Réanimation Polyvalente, Hôpital de Gonesse.
Ann Fr Anesth Reanim. 1990;9(3):309-11. doi: 10.1016/s0750-7658(05)80193-5.
The adult respiratory distress syndrome (ARDS) is rarely due to tuberculosis. Two new cases are reported here. Both were female patients, aged 33 and 41 years. The first, of North African origin, was admitted for epigastralgia, hyperpyrexia and intestinal problems. She underwent an exploratory laparotomy, which only showed oedematous mesenteries. Hepatic and lymph node biopsies revealed an ongoing tuberculosis. On the 4th postoperative day, she developed ARDS. Despite an initial period of improvement after proper treatment (antituberculous drugs, steroids, positive pressure ventilation) had been started, she died 27 days later. In the other patient, smoker and alcoholic, the diagnosis of tuberculosis relied only on bacterial culture of various excretions. She also died after 8 days of treatment. In both patients, the symptoms were atypical. The febrile non cardiogenic pulmonary oedema of sudden onset masked the typical miliary mottling pattern on chest X-rays. The life-threatening character of this condition requires that rapid histological studies are carried out to obtain an early diagnosis. Indeed, the precociousness of appropriate treatment seems to be the essential element of the prognosis.
成人呼吸窘迫综合征（ARDS）很少由结核病引起。本文报告两例新病例。两名均为女性患者，年龄分别为33岁和41岁。首例患者来自北非，因上腹痛、高热和肠道问题入院。她接受了剖腹探查术，结果仅显示肠系膜水肿。肝脏和淋巴结活检显示存在活动性结核病。术后第4天，她出现了ARDS。尽管在开始适当治疗（抗结核药物、类固醇、正压通气）后最初有一段时间有所改善，但她在27天后死亡。另一例患者有吸烟和酗酒史，结核病诊断仅依靠各种排泄物的细菌培养。她在治疗8天后也死亡。两名患者的症状均不典型。突发的发热性非心源性肺水肿掩盖了胸部X光片上典型的粟粒状斑点影。这种疾病危及生命的特性要求进行快速组织学检查以获得早期诊断。事实上，尽早进行适当治疗似乎是预后的关键因素。
