Hashizume Toshihiko, Kawada Kanemitsu
Department of Internal Medicine, Yokohama Sakaekyosai Hospital, 132 Katsura-cho, Sakae-ku, Yokohama, 247-8581, Japan.
Nihon Kokyuki Gakkai Zasshi. 2002 Apr;40(4):304-6.
A 79-year-old man presented with persistent nonproductive cough and high fever. The chest radiograph showed bilateral miliary shadows. We performed bronchoalveolar lavage and transbronchial lung biopsy to assist diagnosis. Severe dyspnea developed after the bronchofiberscopy, when the chest radiograph revealed bilateral ground-glass shadows and the oxygen saturation in the room air fell to 60%. It was suspected that the patient had acute respiratory distress syndrome, so that methylprednisolone was given intravenously at a dose of 250 mg daily for 3 days, which resulted in a reduction in ground glass shadows and an improvement in oxygen saturation. We diagnosed miliary tuberculosis because the transbronchial lung biopsy specimen showed caseous granuloma and the PCR test for Mycobacterium tuberculosis in the bronchoalveolar lavage fluid was positive. The patient was cured with antituberculosis chemotherapy.
一名79岁男性出现持续性干咳和高热。胸部X线片显示双侧粟粒状阴影。我们进行了支气管肺泡灌洗和经支气管肺活检以协助诊断。纤维支气管镜检查后出现严重呼吸困难，此时胸部X线片显示双侧磨玻璃影，室内空气中的氧饱和度降至60%。怀疑该患者患有急性呼吸窘迫综合征，因此静脉给予甲泼尼龙，剂量为每日250毫克，共3天，结果磨玻璃影减少，氧饱和度改善。我们诊断为粟粒性肺结核，因为经支气管肺活检标本显示干酪样肉芽肿，支气管肺泡灌洗液中结核分枝杆菌的PCR检测呈阳性。该患者通过抗结核化疗治愈。
