A 39-year-old woman with ulcerative colitis diagnosed by clinical picture and colon biopsy in December 2008 started treatment with protease 100 mg/day and prednisone 20 mg/day in January 2009.
He remained symptomatic despite treatment and regular control, requiring two hospitalizations in 2009 for reactivation of ulcerative colitis.
In June 2010 she was admitted again due to fever of 15 days of evolution associated with lower gastrointestinal bleeding, severe anemia and diarrhea.
A new colonic complication showed pancolitis, with toxic megacolon or another abdominal one being ruled out.
The chest X-ray showed multiple thin, approximately 3 mm nodules, of random, bilateral, larger to the right, with a TCM pattern and showed microno media ill-defined pulmonary opacity diffuse miliary necrosis with miliary appearance.
The images described were highly suggestive of active pulmonary TBC with bronchiolar and dissemination.
The patient did not present cough, expectoration or hemoptysis, but partial acute respiratory failure was observed.
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Based on the imaging findings, antituberculosis treatment was initiated on July 13, 2010, despite the negative sputum smear results.
That same day, acute respiratory failure due to pneumothorax secondary to the installation of a central venous catheter was accentuated.
A pleural drainage tube was installed and given the eventual need for mechanical ventilation, it was sent to a private clinic in Santiago, as ICU beds were not available in Talca.
In Santiago, the medical team interpreted the case as bronchiolitis obliterans organizing pneumonia (BOOP) and suspended antituberculosis treatment.
She started methylprednione pulse 1 gram/day 3 days, prednisone 1 mg/kg associated with prednisone 1 mg/kg, and stopped taking 100 mg/day due to pleural drainage and coughing.
The evolution was favorable, without requiring mechanical ventilation, being discharged on July 27, 2010.
On August 5, she consulted in the emergency service of the regional hospital of Talca with fever 39oC of four days of evolution, tachypnea, tachycardia and hypotension, initially managed in the medical service and later in the care unit.
Due to the persistence of hemodynamic compromise and suspicion of septic shock, she was admitted to the intensive care unit three days after admission.
On August 10, the patient was evaluated by the respiratory team of the Regional Hospital of Talca and it was decided to restart anti-tuberculosis treatment.
E. coli with progressive respiratory failure requiring invasive mechanical ventilation, hemodynamic support with crystalloids and colloids to maintain stable mean arterial pressure and central venous pressure up to 12 mm/Hg plus norepinephrine up to 0.55 gamma/40 kg
Laboratory and hemodynamic parameters were compatible with septic shock, evolving refractory to the measures indicated, presenting multiple organ failure, before which dies on August 19, 2010.
Bacterial cultures of bronchial secretions, urine and blood were all negative.
No other bacterial infectious focus or abdominal complications derived from ulcerative colitis were demonstrated.
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Bacilitated tracheal aspirates (4) were negative, but 30-day culture of Koch was positive for 20 Mycobacterium tuberculosis colonies, a result received postmortem.
