Piqueras A R, Marruecos L, Artigas A, Rodriguez C
Intensive Care Med. 1987;13(3):175-82. doi: 10.1007/BF00254701.
Although, miliary tuberculosis is an unusual cause of severe acute respiratory failure, we describe nine patients with miliary tuberculosis who developed adult respiratory distress syndrome. This complication occurred in seven patients despite treatment with antituberculous drugs. In two patients who developed the syndrome, miliary tuberculosis was diagnosed only at postmortem. The presence of pulmonary hypertension in all cases and disseminated intravascular coagulation in seven cases suggests a possible pathophysiologic relationship with severe pulmonary vascular damage. The high mortality rate (88.8%) was associated with nonpulmonary organ system failure. Miliary tuberculosis should be considered in patients with adult respiratory distress syndrome of unknown etiology, and simple diagnostic procedures such as sputum, bronchial brushing, and gastric examination should be followed by invasive diagnostic procedures to confirm this etiology. Since untreated miliary tuberculosis is usually fatal, early recognition of this disease is of great importance, and specific therapy may play a lifesaving role.
虽然粟粒性肺结核是严重急性呼吸衰竭的罕见病因，但我们描述了9例发生成人呼吸窘迫综合征的粟粒性肺结核患者。尽管使用了抗结核药物治疗，仍有7例患者出现了这种并发症。在2例发生该综合征的患者中，粟粒性肺结核仅在尸检时才被诊断出来。所有病例均存在肺动脉高压，7例存在弥散性血管内凝血，提示可能与严重的肺血管损伤存在病理生理关系。高死亡率（88.8%）与非肺器官系统衰竭有关。对于病因不明的成人呼吸窘迫综合征患者，应考虑粟粒性肺结核，在进行痰液、支气管刷检和胃液检查等简单诊断程序后，应采用侵入性诊断程序来证实病因。由于未经治疗的粟粒性肺结核通常是致命的，早期识别这种疾病非常重要，特异性治疗可能发挥挽救生命的作用。
