van Ingen Jakko, Boeree Martin, Janssen Matthijs, Ullmann Erik, de Lange Wiel, de Haas Petra, Dekhuijzen Richard, van Soolingen Dick
Department of Pulmonary Diseases, Radboud University, Nijmegen Medical Centre, and the Rijnstate Hospital in Arnhem, The Netherlands.
Nat Clin Pract Rheumatol. 2007 Jul;3(7):414-9. doi: 10.1038/ncprheum0538.
A 54-year-old man with a 22-year history of rheumatoid arthritis and an 8-year history of chronic obstructive pulmonary disease presented with dyspnea on exertion, nonproductive cough and fatigue of 1 month's duration. His medication at presentation consisted of etanercept, azathioprine, naproxen and inhaled fluticasone and salbutamol.
At presentation, the patient underwent physical examination, chest X-ray and high-resolution CT, blood tests, and bronchoalveolar lavage fluid analysis including auramine stains and gene sequence analysis of cultured Mycobacterium szulgai. The patient underwent minithoracotomy after 6 months, and bronchoalveolar lavage fluid analysis, culture and chest X-ray after 18 months. Further chest imaging and culture of sputum samples were performed another year later.
Pulmonary M. szulgai infection.
Triple drug therapy with rifampicin, ethambutol hydrochloride and clarithromycin. Anti-tumor necrosis factor treatment was continued.
一名54岁男性，有22年类风湿关节炎病史和8年慢性阻塞性肺疾病病史，出现劳力性呼吸困难、干咳和持续1个月的乏力。就诊时他正在使用的药物包括依那西普、硫唑嘌呤、萘普生以及吸入用氟替卡松和沙丁胺醇。
就诊时，患者接受了体格检查、胸部X线和高分辨率CT检查、血液检查，以及支气管肺泡灌洗液分析，包括金胺染色和对培养的苏尔加分枝杆菌进行基因序列分析。6个月后患者接受了小开胸手术，18个月后进行了支气管肺泡灌洗液分析、培养和胸部X线检查。1年后进一步进行了胸部影像学检查和痰液样本培养。
肺部苏尔加分枝杆菌感染。
采用利福平、盐酸乙胺丁醇和克拉霉素三联药物治疗。继续进行抗肿瘤坏死因子治疗。
