title: [A case of pulmonary tuberculosis associated with adult respiratory distress syndrome during corticosteroid treatment of rheumatoid arthritis].
abstract: We reported a case of 64 year-old female patient of pulmonary tuberculosis associated with ARDS during corticosteroid treatment of Rheumatoid Arthritis. On admission her chief complaints were fever, fatigue and dyspnea. A chest roentgenogram showed diffuse alveolar infiltration consistent with pulmonary edema. Arterial blood gas studies showed severe hypoxemia. We clinically diagnosed so-called ARDS. Smears of sputum for acid fast bacilli were negative, but transbronchial lung brushing by bronchofiberscope revealed many acid fast bacilli. Intensive therapy with anti-tuberculosis drugs (INH, RFP, SM), high dose corticosteroid (methylprednisolone) therapy and mechanical ventilation was started. During the following 2 weeks, the PaO2 rose gradually and the alveolar infiltration on the chest roentgenogram disappeared. The experience of this case to emphasized the importance of suspecting this condition because pulmonary tuberculosis is a potentially curable cause of ARDS and it should also be emphasized that the good treatment effect could be expected with combined use of high dose corticosteroid and mechanical ventilation.
authors.affiliation: Fist Department of Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Tokunaga
authors.forename: Y
authors.initials: Y
authors.lastname: Ichikawa
authors.forename: M
authors.initials: M
authors.lastname: Kuboshiro
authors.forename: T
authors.initials: T
authors.lastname: Higashi
authors.forename: K
authors.initials: K
authors.lastname: Fujino
authors.forename: M
authors.initials: M
authors.lastname: Kaji
mesh_terms: D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000628:therapy; D014221:Triamcinolone / Q000009:adverse effects*; D014397:Tuberculosis, Pulmonary / Q000150:complications*
chemical_list: D014221:Triamcinolone; D008775:Methylprednisolone