Silent Catastrophe: Severe Pulmonary Tuberculosis in Immunocompetent Young Adults – Case Report

Abstract

Introduction: Pulmonary tuberculosis (TB) remains endemic in Uruguay (37/100,000; mortality 4.2/100,000), and is strongly associated with social vulnerability, overcrowding, and malnutrition. Over the past year, an increase in severe clinical presentations has been observed among young immunocompetent patients, which is unusual in the local epidemiological context.

Methods: A retrospective case series was conducted including patients ≤40 years of age, without previous comorbidities, hospitalized for pulmonary TB with severe complications between 2023 and 2024 at Hospital Maciel (Montevideo). Sociodemographic characteristics, prior healthcare consultations, nutritional status, complications, interventions, and clinical outcomes were collected.

Results: Eight patients were included (mean age 24 years), all with low socioeconomic status and limited educational attainment. All presented advanced forms of pulmonary TB without resistance to first-line antituberculous drugs. Complications included severe respiratory failure, life-threatening hemoptysis, pyopneumothorax, and pleurocutaneous fistula. Patients required high-complexity procedures such as arterial embolization, pleural drainage, Heimlich valve placement, and pleural window. Two patients died due to severe malnutrition and/or severe respiratory failure.

Discussion and Conclusions: Severe pulmonary TB in young immunocompetent patients represents an uncommon clinical profile in Uruguay. Diagnostic delay, social vulnerability, and malnutrition were associated with increased morbidity and mortality, underscoring the need to strengthen early clinical suspicion, improve access to diagnostic tools, and promote health education and social support strategies.