Itoh M, Oida E, Iwai K, Okazaki T, Tashima M, Uchiyama T
Department of Hematology and Oncology, Clinical Sciences for Pathological Organs, Graduate School of Medicine, Kyoto University.
Rinsho Ketsueki. 2001 Mar;42(3):209-15.
A 61-year-old woman with a 6-year history of chronic myelogenous leukemia (CML) presented with recurrent fever in July 1996. Bone marrow aspiration, biopsy and chromosome analysis showed that CML was in the chronic phase. Bone marrow biopsy revealed nonspecific inflammatory lesions. Chest X-ray and computed tomography examinations demonstrated interstitial pneumonia. Cultures of gastric juice and bone marrow yielded colonies of Mycobacterium avium complex (MAC), and a diagnosis of disseminated atypical mycobacteriosis was made. Multidrug treatment including rifampicin, ethambutol, clarithromycin and ciprofloxacin was begun. The cultures subsequently became negative and the fever was resolved. However, fever eventually recurred and the patient died of multiple organ failure in October 1997. since disseminated atypical mycobacteriosis complicating hematological disorders worsens the prognosis, its early diagnosis and prompt treatment are important. Although it is often difficult to identify atypical mycobacterium as a causal agent, frequent culturing of atypical mycobacterium from various sources including bone marrow fluid can be helpful for early diagnosis whenever fever of undetermined origin occurs in patients with hematological disorders.
一名患有慢性粒细胞白血病（CML）6年的61岁女性于1996年7月出现反复发热。骨髓穿刺、活检及染色体分析显示CML处于慢性期。骨髓活检发现非特异性炎症病变。胸部X线和计算机断层扫描检查显示间质性肺炎。胃液和骨髓培养出鸟分枝杆菌复合体（MAC）菌落，诊断为播散性非典型分枝杆菌病。开始使用包括利福平、乙胺丁醇、克拉霉素和环丙沙星在内的多药治疗。随后培养结果转为阴性，发热消退。然而，发热最终复发，患者于1997年10月死于多器官功能衰竭。由于播散性非典型分枝杆菌病并发血液系统疾病会使预后恶化，其早期诊断和及时治疗很重要。尽管通常很难将非典型分枝杆菌确定为病因，但当血液病患者出现不明原因发热时，从包括骨髓液在内的各种来源频繁培养非典型分枝杆菌有助于早期诊断。
