Disseminated tuberculosis with acute respiratory distress syndrome lacking granuloma formation in the lung

Case report: Miliary tuberculosis complicated by pediatric acute respiratory distress syndrome in a 12-year-old girl

“…After effective treatment, her condition improved, and her CD4 + T cell count increased to 219/μl, although it remained below normal. This and several previously reported cases ( 32 – 35 ) suggest that dexamethasone may suppress cellular immune function, leading to a decline in resistance to Mtb and the dissemination of Mtb. CD4 + T cells play a crucial role in the containment of Mtb ( 36 ).…”

“…Typical imaging findings of miliary TB include miliary nodules characterized by a uniform size, distribution, and density. The miliary nodules may be obscured by infiltrating ground-glass opacities of ARDS (31)(32)(33). In this case, the patient already had infiltrates on chest CT before admission, which may have been an early sign of PARDS.…”

Illustration of a number of atypical computed tomography manifestations of active pulmonary tuberculosis

“…According to the presence or absence of miliary nodules, the imaging appearance of blood-borne tuberculosis with diffuse GGO can be divided into predominantly diffuse GGO manifestation and diffuse GGO with miliary nodules manifestation. The predominantly diffuse GGO manifestation of PTB mainly occurs in cases of hematogenously disseminated tuberculosis with DAD, which is a high-risk factor for acute respiratory distress syndrome (ARDS) (32,33). Diffuse GGO mode is mostly due to impaired immune function, and granulomas do not form or form poorly (Figures 12,13).…”

“…In secondary tuberculosis with this type of manifestation, GGO is often accompanied by pulmonary consolidation, cavities, nodules and other signs (32)(33)(34)(35)(36).…”