Tuberculosis-associated Immune Thrombocytopenia: A Case Report

Al Argan, Reem J.; Al Elq, Abdulmohsen H.

The patient was admitted to the isolation unit as a case of community-acquired pneumonia to rule out H1N1 and corona viral infections as well as TB. He was treated with ceftriaxone, azithromycin and oseltamivir. The screening of H1N1 and corona virus were negative. On Day 3 post-admission, the patient was still febrile, looking ill, dyspneic and tachypneic. Arterial blood gas (ABG) analysis revealed a pH 7.23, PCO 2 25.5 mmHg, HCO 3 12.9 mmol/L, PO 2 85 mmHg, oxygen saturation 94.6% on 4 L/min oxygen through nasal cannula; RFT: BUN 68 mg/dl, creatinine 2.99 mg/dl, Na 129 mg/ dl, K 4.7 mg/dl, CO 2 13.9 mEq/L and anion gap (AG) 15. His chest X-ray showed worsening pneumonic infiltrations [ Figure 2 ], which necessitated changing antibiotics to levofloxacin. However, his condition continued to deteriorate with a repeat ABG showing a pH 7.38, PCO 2 20 mmHg , PO 2 57 mmHg, HCO 3 11.9 mmol/L, oxygen saturation 90% on face mask 7-10 L/min and picture of acute respiratory distress syndrome on the chest X-ray. Subsequently, he was intubated and mechanically ventilated. He was also started on continuous renal replacement therapy by the nephrology team for acute kidney injury (RFT: BUN was 109 mg/dl, creatinine 5.3 mg/dl, Na 132 mg/dl, K 6.5 mg/dl, CO 2 14 mEq/L and AG 14).