Pulmonary Tuberculosis Presenting as Severe Acute Respiratory Distress Syndrome in a Capsule Hotel Resident

We report a case of a 60-year-old man who developed severe respiratory failure after collapsing in a sauna facility. Initially diagnosed with severe community-acquired pneumonia and acute respiratory distress syndrome (ARDS), his condition deteriorated despite standard treatment, necessitating venovenous extracorporeal membrane oxygenation (VV-ECMO). Acid-fast bacilli testing confirmed pulmonary tuberculosis (TB) on day 4, prompting the initiation of anti-TB therapy. Following clinical improvement, the patient was successfully weaned from VV-ECMO and transferred to a specialized TB hospital for ongoing care. This case highlights the importance of considering TB in cases of antibiotic-refractory severe pneumonia and ARDS, particularly in patients with social risk factors, even in low-incidence countries. Early recognition and treatment of TB are crucial to improving patient outcomes and minimizing transmission risks.