[A rare cause of acute respiratory distress syndrome in adults: acute disseminated pulmonary tuberculosis. Four cases (author's transl)].

Four cases of acute respiratory distress syndrome due to miliary tuberculosis are reported. All four patients had tuberculin anergy; three developed disseminated intravascular coagulation. All were treated early with anti-tuberculous drugs. Three patients were intubated and ventilated with positive end expiratory pressure, but they died shortly afterwards. The fourth patient was treated with continuous positive airway pressure and corticosteroids and survived. In view of such reports, the possibility of tuberculosis should be considered systematically in all adult patients with unexplained acute respiratory distress syndrome. The extremely rapid course of the disease and the inconsistent results of standard examinations for tuberculosis justify an "aggressive" diagnostic approach. Extra-pulmonary biopsies, notably of the bone marrow, are very helpful.