Diagnosis and treatment of severe tuberculosis complicated by ARDS and MODS in a young immunosuppressed host: a case report

Background Severe tuberculosis (TB) presents with complex clinical manifestations and high mortality. Immunosuppressed hosts are at high risk for TB infection and prone to progress to severe disease. Case presentation A young female patient was admitted to our Respiratory Intensive Care Unit with fever, cough, and progressive dyspnea. She had a history of nephrotic syndrome and was on long-term corticosteroids and immunosuppressive agents, but without TB screening at baseline. Following admission, she rapidly developed acute respiratory distress syndrome (ARDS), diffuse alveolar hemorrhage, and multiple organ dysfunction syndrome (MODS). While providing broad-spectrum anti-infective therapy, invasive mechanical ventilation, continuous renal replacement therapy, and supportive care to maintain vital signs, we achieved an early definitive diagnosis of disseminated tuberculosis through rapid sputum acid-fast bacilli staining, Mycobacterium tuberculosis nucleic acid testing, and metagenomic next-generation sequencing (mNGS). A multidisciplinary team collaborated to formulate an individualized anti-tuberculosis treatment plan, leading to a favorable clinical outcome. Conclusion This case highlights the necessity of TB screening in immunosuppressed hosts, early recognition of severe TB, the importance of precise etiological diagnosis, and emphasizing the application of comprehensive treatment strategies in such patients.