Disseminated Tuberculosis Complicated with Disseminated Intravascular Coagulation (DIC) in an Immigrant Patient

Abstract

Disseminated tuberculosis (TB) is rare, can affect any organ system, and predominantly presents in immunocompromised populations. While pulmonary tuberculosis (TB) is prevalent in developing countries, it is an uncommon cause of disseminated TB. In pediatric populations, particularly in the first and second decades of life, disseminated TB is often secondary to lung infections. However, there have been few reports of disseminated TB complicated by disseminated intravascular coagulation (DIC). Disseminated TB is defined as the involvement of two or more noncontiguous sites due to the lymphohematogenous spread of Mycobacterium tuberculosis. Extrapulmonary involvement occurs in one-fifth of all TB cases and may present
without histological or radiological evidence of pulmonary infection. An eleven-year-old girl presented to the emergency department (ED) with complaints of weight loss and abdominal pain. She had no history of immunodeficiency but had been in contact with TB patients. On admission, she exhibited refractory coagulopathy, necessitating transfer to the pediatric intensive care unit (PICU). In the PICU, intravenous vitamin K, fresh frozen plasma (FFP), and packed red blood cells (PRBCs) were administered on the 14th day of admission, following the initiation of antibiotics and a combination of standard anti-tuberculous drugs.
It can be speculated that many pediatric cases of TB-induced pneumonia leading to acute respiratory distress syndrome (ARDS) remain unreported in the literature. More robust data on the epidemiology of childhood TB are necessary to better understand its contribution to ARDS and to develop pediatric-specific therapeutic strategies. Some risk factors for disseminated TB include young age, recent measles infection, immunodeficiency, malnutrition, and malignancies. Children, especially infants and immunocompromised patients, are at higher risk of developing miliary and disseminated TB. However, none of these contributing factors were identified in this child. In the present case, the patient had no HIV infection or immunodeficiency but was an immigrant from an endemic country and had a history of contact with TB patients. The onset
of her symptoms closely resembled those of inflammatory bowel disease (IBD), and she later developed coagulation disorders and DIC. We successfully treated disseminated TB complicated by DIC using antibiotics, FFP, PC, vitamin K, and anti-tuberculous therapy. The follow-up indicated an improvement in her condition and the resolution of symptoms.