Miyake S, Ohdama S, Kumagai T, Ishikawa M, Umino T, Takano S, Akagawa S, Aoki N, Matsubara O
First Department of Internal Medicine, Tokyo Medical and Dental University, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1992 Sep;30(9):1770-6.
A 47-year-old woman with chronic myelogenous leukemia was treated with daily busulfan (total dose approximately 500 mg) from December 1988 to January 1990. The disease thereafter remained stable with no evidence of blastic transformation. In February 1990 she developed productive cough and abnormal acinar lung shadows appeared transiently on her chest X-ray. In October 1990, productive cough and linear and abnormal acinar lung shadows reappeared. Expectorated sputa contained acid-fast bacilli (Gaffky 6, 10). Antituberculous therapy was started, which caused severe liver dysfunction. She was admitted to our hospital for evaluation of abnormal lung shadows. Transbronchial lung biopsy revealed pulmonary alveolar proteinosis with thickening of alveolar septa. The alveolar septal thickening was suspected to be a pathological change following pulmonary alveolar proteinosis. Cultures from sputum, cerebrospinal fluid, and bone marrow aspiration specimens revealed atypical mycobacterium (M. avium complex), and the diagnosis of disseminated atypical mycobacteriosis was established. The pathogenesis of the disseminated atypical mycobacteriosis was considered to be superinfection by mycobacteria.
一名47岁的慢性粒细胞白血病女性患者于1988年12月至1990年1月期间接受了每日白消安治疗（总剂量约500mg）。此后疾病保持稳定，无原始细胞转化迹象。1990年2月，她出现咳痰，胸部X线片上短暂出现异常腺泡样肺阴影。1990年10月，咳痰及线性和异常腺泡样肺阴影再次出现。咳出的痰液中含有抗酸杆菌（盖夫基6级、10级）。开始抗结核治疗，但导致严重肝功能障碍。她因肺部异常阴影来我院就诊。经支气管肺活检显示为肺泡蛋白沉积症伴肺泡间隔增厚。肺泡间隔增厚被怀疑是肺泡蛋白沉积症后的病理改变。痰液、脑脊液和骨髓穿刺标本培养发现非典型分枝杆菌（鸟分枝杆菌复合群），确诊为播散性非典型分枝杆菌病。播散性非典型分枝杆菌病的发病机制被认为是分枝杆菌的重叠感染。
