Ohyama Shinichirou, Murayama Takako, Hasegawa Yoshinori, Nakata Masumi, Hatachi Yukimasa, Bando Kenshi
Department of Respiratory Medicine, Osaka Saiseikai Nakatsu Hospital, 2-10-39, Shibata, Kitaku, Osaka, Japan.
Nihon Kokyuki Gakkai Zasshi. 2003 Sep;41(9):676-80.
A 68-year-old man was admitted because of fever and weight loss. A chest high-resolution computed tomography (HRCT) scan revealed diffuse micronodular shadows, and an abdominal CT scan showed an aneurysm spreading from the root of the renal artery to the iliac bifurcation. His fever subsided without treatment and his general condition was good. However, histological studies of a transbronchial lung biopsy specimen and bone marrow aspirate clot revealed non-necrotizing epitheloid granulomas, and mycobacterium tuberculosis was cultured from sputum and bronchoalveolar lavage fluids. Military tuberculosis was diagnosed. One month after the initiation of chemotherapy, the abdominal aneurysm enlarged quickly despite the improvement of the thoracic findings, and graft replacement was performed. Histological findings in specimens of the resected aneurysm suggested that tuberculous inflammation of the surrounding lymph nodes had invaded the aortic wall, leading to the aneurysm. It should be borne in mind that symptoms in elderly patients with miliary tuberculosis may be mild, even when serious extrapulmonary lesions are present.
一名68岁男性因发热和体重减轻入院。胸部高分辨率计算机断层扫描（HRCT）显示弥漫性微小结节阴影，腹部CT扫描显示一个动脉瘤从肾动脉根部延伸至髂总动脉分叉处。未经治疗，他的发热症状消退，一般状况良好。然而，经支气管肺活检标本和骨髓穿刺凝块的组织学研究显示非坏死性上皮样肉芽肿，痰和支气管肺泡灌洗液培养出结核分枝杆菌。诊断为粟粒性肺结核。化疗开始一个月后，尽管胸部症状有所改善，但腹部动脉瘤迅速增大，遂进行了移植置换手术。切除动脉瘤标本的组织学结果表明，周围淋巴结的结核性炎症侵犯了主动脉壁，导致动脉瘤形成。应牢记，老年粟粒性肺结核患者即使存在严重的肺外病变，症状也可能较轻。
