Acute respiratory distress syndrome triggered by pulmonary tuberculosis and influenza coinfection that required veno-venous ECMO support

Abstract

Pulmonary tuberculosis can progress to severe forms such as acute respiratory distress syndrome (ARDS), especially in the presence of co-infections that modulate the host’s immune response. Influenza infection has been associated with increased severity of tuberculosis, contributing to clinical deterioration and progression to acute respiratory failure. In this context, extracorporeal membrane oxygenation (ECMO) represents a rescue strategy in patients with refractory hypoxemia.

We present the case of a 19-year-old woman, previously healthy, with subacute respiratory symptoms and systemic symptoms, whose chest CT scan revealed consolidations, cavitated lesions, and a tree-like pattern suggestive of pulmonary tuberculosis. Microbiological confirmation of the infection was performed via smear microscopy and polymerase chain reaction (PCR). During her course of illness, she experienced clinical deterioration with the development of severe ARDS and refractory hypoxemia (PaO₂/FiO₂ < 80), requiring invasive mechanical ventilation and, subsequently, veno-venous ECMO support. Coinfection with influenza A (H1N1) was documented and interpreted as a trigger for respiratory deterioration. The patient received antituberculosis and antiviral treatment, with a favorable outcome and successful weaning from ECMO after 21 days of support.

This case highlights the pathophysiological interaction between tuberculosis and influenza as a possible mechanism amplifying lung damage and progression to ARDS. It also highlights the role of ECMO as a rescue therapy in patients with ARDS secondary to complex pulmonary infections, underscoring the importance of early recognition and comprehensive management in such clinical scenarios.