Hsieh Hsiao-Cheng, Lu Po-Liang, Chen Tun-Chieh, Chang Ko, Chen Yen-Hsu
Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan.
Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
J Med Microbiol. 2008 May;57(Pt 5):664-667. doi: 10.1099/jmm.0.47574-0.
Thoracic empyema caused by rapidly growing mycobacteria (RGM) and complicated with bronchopleural fistula is rarely reported, especially in immunocompetent patients. A 53-year-old healthy woman presented initially with a productive cough and intermittent fever. The patient received a complete treatment course following an initial diagnosis of pulmonary tuberculosis. After the anti-tuberculosis agents were discontinued, a right thoracic empyema with bronchopleural fistula occurred, and the pathogens from both pus and sputum were identified as Mycobacterium chelonae. Thoracotomy with decortication and wedge resection of the right middle lung was performed, followed by clarithromycin plus ciprofloxacin therapy for 36 months. This patient has not suffered a relapse in the last 3 years. In addition to the experience of successful treatment, this case indicates that RGM such as M. chelonae can emerge as causative pathogens of thoracic empyema, even in healthy persons.
由快速生长分枝杆菌（RGM）引起并合并支气管胸膜瘘的胸腔积脓很少见报道，尤其是在免疫功能正常的患者中。一名53岁健康女性最初表现为咳痰和间歇性发热。该患者在初步诊断为肺结核后接受了完整疗程的治疗。停用抗结核药物后，出现了伴有支气管胸膜瘘的右侧胸腔积脓，脓液和痰液中的病原体均被鉴定为龟分枝杆菌。进行了开胸剥脱术和右中肺楔形切除术，随后给予克拉霉素加环丙沙星治疗36个月。该患者在过去3年中未复发。除了成功治疗的经验外，该病例表明，即使在健康人中，龟分枝杆菌等RGM也可能成为胸腔积脓的致病病原体。
