Milijarna tuberkuloza sa akutnim respiracijskim distres sindromom kod bolesnice sa Daunovim sindromom

  • Ljiljana Novković University of Kragujevac, Faculty of Medical Science, Clinical Centre Kragujevac, Clinic for Pulmonology, Kragujevac, Serbia
  • Zorica Lazić University of Kragujevac, Faculty of Medical Science, Clinical Centre Kragujevac, Clinic for Pulmonology, Kragujevac, Serbia
  • Marina Petrović University of Kragujevac, Faculty of Medical Science, Clinical Centre Kragujevac, Clinic for Pulmonology, Kragujevac, Serbia
  • Ana Vujić University of Kragujevac, Faculty of Medical Science, Clinical Centre Kragujevac, Department of Pediatrics, Kragujevac, Serbia
  • Andjelka Stojković University of Kragujevac, Faculty of Medical Science, Clinical Centre Kragujevac, Department of Pediatrics, Kragujevac, Serbia
  • Ivan Čekerevac University of Kragujevac, Faculty of Medical Science, Clinical Centre Kragujevac, Department of Pediatrics, Kragujevac, Serbia
DOI: https://doi.org/10.2298/VSP180129108N
Ključne reči: daunov sindrom, tuberkuloza, milijarna, respiratorni distres sindrom kod odraslih

Sažetak


Uvod. Milijarna tuberkuloza (TB) je retka, potencijalno fatalna forma diseminovane TB. Nastaje masivnom hematogenom diseminacijom Mycobacterium tuberculosis iz aktivnog kazeoznog fokusa u različite organe. Ponekad može da ima akutnu prezentaciju sa brzim kliničkim pogoršanjem i smrću. Milijarna TB komplikovana akutnim respiratornim distres sindromom (ARDS) koji zahteva mehaničku ventilaciju (MV) je retka čak i u zemljama sa visokom incidencijom TB. Prikaz bolesnice. Trideset petogodišnja žena sa Daunovim sindromom (DS) je bila primljena u Kliniku za pulmologiju zbog ispitivanja kašlja i gubitka telesne mase tokom poslednja dva meseca. Laboratorijski nalazi su ukazali na anemiju, leukocitozu, povećanu vrednost C reaktivnog proteina (CRP) i hipoalbuminemiju. Radiografijom grudnog koša su ustanovljene bilateralne retikulonodularne senke, dominantno u srednjem i donjem plućnom polju, desno. Tuberkulinski kožni test (Purified protein derivative – PPD test) i razmaz sputuma na acidorezistentne bacile (ARB) su bili negativni. Petog dana od prijema, stanja bolesnice se naglo pogoršalo, razvio se umereni ARDS i bolesnica je stavljena na mehaničku ventilaciju. Zbog visoke kliničke sumnje na milijarnu TB i životno ugrožavajućeg stanja bolesnice uvedena je empirijska terapija antituberkuloticima. Uprkos preduzetih terapijskih i potpornih mera, nakon tri dana došlo je do letalnog ishoda. Dijagnoza milijarne TB je postavljena obdukcionim nalazom. Zaključak. Milijarnu TB treba imati na umu kod bolesnika sa DS zbog imunosupresije povezane sa deficitom ćelijski posredovanog imuniteta. Razvoj ARDS, kao komplikacije milijarne TB, težak je za prepoznavanje zbog njihove slabe uzročne povezanosti. Visok stepen kliničke sumnje i tipični milijarni uzorak na radiografiji grudnog koša opravdavaju započinjanje empirijske terapije antituberkuloticina kod ovih bolesnika, u pokušaju da se promeni loša prognoza.

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Objavljeno
2021/04/19
Broj časopisa
Vol. 77 Br. 6 (2020): Vojnosanit pregl
Rubrika
Prikaz bolesnika