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Tuberculosis (T continues to be a major cause of death worldwide and can have varying manifestations. Acute respiratory distress syndrome (ARDS) is a rare complication of the clinical course of TB but carries a high mortality rate. We present a case of a diabetic African-American patient, with acute respiratory failure, rapidly progressing to ARDS secondary to TB, which had a fatal outcome. Clinicians should keep a high suspicion index for TB in the setting of ARDS since the use of empiric anti-TB treatment could potentially reduce mor
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