title: Acute respiratory distress syndrome in disseminated tuberculosis: an uncommon association.
abstract: OBJECTIVE
  To analyse clinicopathological features of acute respiratory distress syndrome (ARDS) in disseminated tuberculosis (TB) at autopsy.
  
  
  METHODS
  A retrospective analysis of an autopsy database of disseminated TB from 1990 to 2010 was conducted. ARDS cases were assessed for histological changes of diffuse alveolar damage (DAD) and other pathological pulmonary features.
  
  
  RESULTS
  Disseminated TB was diagnosed in 196 cases. The clinical diagnosis of disseminated TB was made in 67% of cases. Of the 196 cases, 10 met the clinical criteria for ARDS, 60% of whom showed histological evidence of DAD. One case of DAD was diagnosed on histology alone. DAD was thus found in 7/196 cases of disseminated TB. Other pulmonary changes included necrotising granulomas (n = 10), tuberculous bronchopneumonia (n = 4), tuberculous vasculitis (n = 3), infarction (n = 1) and aspergilloma (n = 1). Histopathological diagnosis other than DAD was found in 4/10 cases and disseminated TB was presumed clinically in only 4/10 cases of ARDS.
  
  
  CONCLUSIONS
  Disseminated TB may be clinically missed and diagnosed only post mortem. Disseminated TB is a relatively uncommon cause of ARDS; however, it should always be presumed clinically as it is a potentially treatable cause. DAD is a rare histological feature of disseminated TB and there may not always be a clinicopathological correlation between ARDS and DAD.
authors.affiliation: Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: S
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: U
authors.initials: U
authors.lastname: Nahar
authors.affiliation: Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: A
authors.initials: A
authors.lastname: Das
authors.affiliation: Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: B
authors.initials: B
authors.lastname: Radotra
authors.affiliation: Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: K
authors.initials: K
authors.lastname: Joshi
authors.affiliation: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: S
authors.initials: S
authors.lastname: Varma
authors.affiliation: Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: R K
authors.initials: RK
authors.lastname: Vasishta
mesh_terms: D000328:Adult; D001344:Autopsy; D002423:Cause of Death; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D011650:Pulmonary Alveoli / Q000382:microbiology / Q000473:pathology*; D012128:Respiratory Distress Syndrome / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D014391:Tuberculosis, Miliary / Q000150:complications / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D055815:Young Adult