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Introduction La tuberculose est la complication infectieuse la plus frequente des patients infectes par le virus de l’immunodeficience humaine (VIH). Son incidence ainsi que la proportion des formes disseminees augmentent avec l’immunosuppression. L’apparition d’un choc septique et d’une defaillance multiviscerale est rare mais augmente fortement la mortalite. Observation Un patient de 44 ans seropositif pour le VIH est admis en reanimation pour une detresse respiratoire aigue. Il est febrile depuis deux semaines, sur la radiographie thoracique on observe un discret syndrome interstitiel et l’endoscopie bronchique montre des granulations blanchâtres endobronchiques. Toutes les investigations bacteriologiques etaient negatives au moment de l’admission. Le patient decede 16 heures plus tard en raison d’une defaillance multiviscerale. L’examen direct et la culture du lavage bronchoalveolaire ainsi que les hemocultures et la biopsie hepatique post mortem montreront la presence de mycobacteries. Conclusion Le choc septique est une complication rare de la tuberculose disseminee. La mortalite est tres elevee dans ce contexte. Un traitement precoce, notamment en cas de tres forte suspicion de tuberculose, est necessaire.

Acute respiratory distress syndrome caused by Mycoplasma pneumoniae infection has rarely been described.We report a case of community-acquired pneumonia occurring in a patient with Down's syndrome. Persisting hypoxemia raised the questions of nosocomial pneumonia, of the occurrence of a fibrosing alveolitis or of the resistance of the strain to macrolides. After a long period of very severe respiratory impairment, the evolution was progressively favourable and the patient was discharged from ICU with full respiratory recovery 43 days after admission.Acute respiratory distress syndrome caused by M. pneumoniae infection is rare but must be considered when the appropriate clinical and radiological pattern occurs. The question of the susceptibility of the strain to macrolides has to be raised in some circumstances.

Tuberculosis is the most common infectious complication in HIV infected patients. The incidence of tuberculosis and the proportion of disseminated disease increase with more severe immuno-suppression. Septic shock and multiple organ failure are uncommon but are of markedly bad prognostic significance.A forty-four year old HIV seropositive man was admitted to the intensive care unit (ICU) with acute respiratory distress. The patient had been febrile for the previous two weeks. His thoracic radiograph showed a discrete interstitial infiltrate and at bronchoscopy small whitish granulations were observed in the main bronchi. All bacteriological investigations remained negative at the time of ICU admission. The patient died sixteen hours later due to multiple organ failure. Mycobacteria were identified after patient's death on the smear from BAL, from blood cultures, and in a postmortem liver biopsy.Septic shock is an infrequent complication of disseminated tuberculosis. Mortality is very high. Treatment should be started early in cases with a high diagnostic suspicion.