RAPID RECOVERY FROM MYCOBACTERIUM TB EPIGLOTTITIS REQUIRING ENDOTRACHEAL INTUBATION

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Laryngeal Tuberculosis (LTb) currently accounts for <1% of all Tb cases. Patients most often present with dysphonia, weight loss, and typically respond well to targeted antimicrobial regimens [1]. To our knowledge, there is minimal data regarding time liberation from mechanical ventilation the efficacy corticosteroids in LTb. We a case LTb 37-year-old immunocompetent female requiring endotracheal intubation subsequent rapid recovery. CASE PRESENTATION: A presented Emergency Department 2-week history dyspnea, 3 months intermittent fevers, dysphonia. She had no known past medical history. The patient was febrile, tachycardic, hypoxic 100% oxygen via non-rebreather mask. Physical exam remarkable respiratory distress mild stridor. Laboratory studies found leukocytosis 18.3 K/μL neutrophilic predominance 84%. HIV screening negative. CXR revealed bilateral interstitial opacities. CT angiography diffuse, centrilobular nodules, tree-in-bud opacities, upper lobe cavitary lesions measuring up 3.9cm (Image 1). Contrast-enhanced Neck demonstrated marked swelling epiglottis moderate narrowing airway 2). Nebulized racemic epinephrine, albuterol, ipratropium, IV dexamethasone resulted improvement her Transnasal flexible fiberoptic laryngoscopy an enlarged >50% obstruction supraglottic airway. underwent protection, bronchoscopy performed. Bronchoalveolar lavage fluid analysis 95% neutrophils, cultures grew Mycobacterium tuberculosis, cytology negative malignant cells. Rifampin, isoniazid, pyrazinamide, ethambutol (RIPE), pyridoxine were initiated. also received 6mg daily seven days. Twelve days after intubation, extubated without signs DISCUSSION: has two categories: primary, which bacteria seed larynx directly, secondary, invasion by advanced pulmonary Diagnosis combination visualization laryngeal laryngoscopy, tissue culture, histopathology review literature identified 13 cases ventilation, tracheostomy. Time decannulation ranged 2-6 months, one reporting 2 weeks [2]. Data compromise limited. However, recent retrospective study steroid use acute failure be beneficial [3]. CONCLUSIONS: When treated appropriate antimicrobials along consideration adjunct corticosteroid use, patients may demonstrate recovery obviating need REFERENCE #1: Benwill JL, Sarria JC. tuberculosis United States America: forgotten disease. Scand J Infect Dis. 2014;46(4):241-249. doi:10.3109/00365548.2013.877157 #2: Gupta R, Fotedar S, Sansanwal P, et al. Obstructing mass lesion epiglottis: it can tubercular. Indian Tuberc. 2008;55(2):100-103. #3: Yang JY, Han M, Koh Y, Effects Corticosteroids on Critically Ill Pulmonary With Acute Respiratory Failure: Propensity Analysis Mortality. Clin 2016;63(11):1449-1455. doi:10.1093/cid/ciw616 DISCLOSURES: No relevant relationships Nathaniel Allison, source=Web Response Christopher Lee, John Prudenti, Lourdes Sanso,