Kuboi Satoshi, Nomura Hideyuki
Department of Internal Medicine, Shin-Kokura Hospital.
Kansenshogaku Zasshi. 2006 Mar;80(2):119-23. doi: 10.11150/kansenshogakuzasshi1970.80.119.
A 46-year-old man was admitted to Shin-Kokura Hospital because of fever and right chest pain. Laboratory studies showed mild leukocytosis, an increased erythrocyte sediment rate, positive C-reactive protein, and abnormal liver function. The tuberculin skin test was positive. A chest X-ray showed massive right pleural effusion, and exudative pleural effusion fluid was obtained by thoracocentesis. The pleural fluid revealed an increased adenosine deaminase concentration and cultures were negative for mycobacteria. A polymerase chain reaction test of the pleural effusion for Mycobacterium tuberculosis was positive. The patient was diagnosed with tuberculous pleuritis, and antitubercular therapy was started. The fever and chest pain was improved, but rashes appeared on the lower extremities. A biopsy of the skin lesion showed anaphylactoid purpura. Steroid ointment improved the skin lesion. Anaphylactoid purpura associated with tuberculosis is rare. The immunological response to mycobacteria may heve been related to the mechanism of the anaphylactoid purpura in this case.
一名46岁男性因发热和右胸痛入住新小仓医院。实验室检查显示轻度白细胞增多、红细胞沉降率升高、C反应蛋白阳性及肝功能异常。结核菌素皮肤试验呈阳性。胸部X线显示右侧大量胸腔积液，胸腔穿刺术获取渗出性胸腔积液。胸腔积液腺苷脱氨酶浓度升高，分枝杆菌培养阴性。胸腔积液结核分枝杆菌聚合酶链反应检测呈阳性。该患者被诊断为结核性胸膜炎，并开始抗结核治疗。发热和胸痛有所改善，但下肢出现皮疹。皮肤病变活检显示为过敏性紫癜。类固醇软膏使皮肤病变好转。与结核病相关的过敏性紫癜罕见。对分枝杆菌的免疫反应可能与该病例中过敏性紫癜的发病机制有关。
