A SHOCKING CASE OF DISSEMINATED TB

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: BH is a 41-year-old Nepalese male with history of ulcerative colitis (recently on adalimumab) and type two diabetes mellitus was transferred for the evaluation ECMO. He presented to an outside hospital days prior complaint fevers, hemoptysis, five-pound weight loss over one month. Despite pre-biologic testing showing indeterminate interferon, negative acid fast culture normal chest x-ray, CT scan his revealed diffuse miliary pattern, consistent tuberculosis. CASE PRESENTATION: On arrival, patient intubated required norepinephrine, vasopressin phenylephrine maintain mean arterial pressures 65 mmHg. White blood cell count 5.75 K/uL, lactic 6.5 mmol/L, troponin 0.5 ng/mL, brain natriuretic peptide 66,716 pg/mL, ALT 2827 unit/L AST greater than 7000 unit/L, concerning shock. Patient anuric which continuous renal replacement therapy initiated. An echocardiogram showed ejection fraction 20-25%. Dobutamine started due rising lactate despite adequate pressure. not candidate ECMO given presumed TB infection. Amikacin, Moxifloxacin, Meropenem, Ethambutol Amphotericin. After week, he weaned from pressors extubated. also regained function. A repeat weeks following demonstrated improvement 50%. Acid bacillus confirmed DISCUSSION: Adalimumab, TNF-α inhibitor, are among biologic medications that used in treatment colitis. Although its main infectious complications tuberculosis, there can be other side effects including initiation heart failure, cytopenia, elevated transaminases [4]. All mentioned may worsen clinical picture septic There only handful cases, some pediatric literature [3], conveys degree sepsis related disseminated Most tuberculosis often setting human immunodeficiency virus or pediatrics CONCLUSIONS: This case highlights atypical presentation masquerading as shock recent adalimumab use. screen, it possible develop during therapy. Our suggests utility retest individuals who at high risk developing those indeterminant interferon results. REFERENCE #1: George S, Papa L, Sheils Magnussen CR. Septic Clin Infect Dis. 1996 Jan;22(1):188-9. doi: 10.1093/clinids/22.1.188. PMID: 8825004. #2: Hess Hospach T, Nossal R, Dannecker G, Magdorf K, Uhlemann F. Life-threatening complication blockade adolescent. Eur J Pediatr. 2011 Oct;170(10):1337-42. 10.1007/s00431-011-1501-y. Epub May 31. 21625932. #3: Mark S. Godfrey, Lloyd N. Friedman, Tuberculosis Biologic Therapies: Anti-Tumor Necrosis Factor-α Beyond, Clinics Chest Medicine, Volume 40, Issue 4, 2019, Pages 721-739, ISSN 0272-5231, ISBN 9780323682152, https://doi.org/10.1016/j.ccm.2019.07.003.[4] Scheinfeld Adalimumab: review effects. Expert Opin Drug Saf. 2005 Jul;4(4):637-41. 10.1517/14740338.4.4.637. 16011443. DISCLOSURES: No relevant relationships by Saad Ashraf, source=Web Response Fiyad Haniff, ANDRY VAN DE LOUW,