Hyperacute Fulminant Pulmonary Tuberculosis Complicated by Acute Respiratory Distress Syndrome in a Patient Without Recognised Immunocompromise Successfully Managed With Veno-Venous Extracorporeal Membrane Oxygenation: A Case Report

Tuberculosis (TB) remains a major global health challenge, although its clinical course is typically indolent.Acute fulminant presentations complicated by acute respiratory distress syndrome (ARDS) are rare and may pose a significant diagnostic challenge due to overlap with more common causes of severe pneumonia.Evidence regarding the use of extracorporeal membrane oxygenation (ECMO) in TB-associated ARDS remains limited, but it may represent a rescue strategy in carefully selected patients.We present the case of a previously healthy 34-year-old woman who developed acute respiratory failure secondary to fulminant pulmonary tuberculosis.She presented with a 10-day history of dry cough, fever, anorexia, and pleuritic chest pain, initially diagnosed as community-acquired pneumonia.Despite broadspectrum antibiotic therapy, she developed rapidly progressive hypoxaemic respiratory failure requiring invasive mechanical ventilation and fulfilled the criteria for severe ARDS.Initial bronchoalveolar lavage (BAL) analysis, including acid-fast staining and culture, was negative, delaying microbiological confirmation.Subsequent polymerase chain reaction (PCR) testing of respiratory samples identified Mycobacterium tuberculosis complex, and antituberculous therapy (ATT) was initiated.Due to refractory hypoxaemia despite optimised ventilatory strategies and prone positioning, veno-venous ECMO was initiated.The patient demonstrated progressive clinical improvement, allowing extubation and ECMO decannulation, with eventual discharge on room air while continuing antituberculous therapy.Fulminant TB-associated ARDS is an uncommon but severe manifestation that may occur even in young immunocompetent individuals without recognised risk factors.Early consideration of TB in patients with unexplained severe respiratory failure is essential, and rapid molecular diagnostic methods may facilitate earlier initiation of targeted therapy.Although current evidence regarding ECMO in this setting is limited, available data suggest that it can be considered in selected patients with potentially reversible disease, particularly those with favourable baseline characteristics.