Taniguchi Hirokazu, Izumi Saburo
Department of Internal Medicine, Toyama Prefectural Central Hospital, 2-2-78, Nishinagae, Toyama-shi, Toyama 930-8550, Japan.
Kekkaku. 2008 May;83(5):431-4.
A 70-year-old woman afflicted with rheumatoid arthritis was consulted another hospital because of fever and abnormality in chest X-ray. She had been treated with methotrexate and infliximab for seven months. She was diagnosed as methotrexate-induced pneumonia, and was administrated large therapeutic doses of corticosteroid, but finding of her chest X-ray exacerbated. Her sputum examination was positive for Mycobacterium tuberculosis complex by nucleic-acid amplification test, and she was diagnosed as miliary tuberculosis. She was treated with INH, RFP, EB, and PZA, and showed good clinical response to treatment. When infliximab is prescribed, we have to bear in mind possible complication of tuberculosis.
一名70岁患类风湿性关节炎的女性因发热和胸部X光异常而到另一家医院就诊。她已接受甲氨蝶呤和英夫利昔单抗治疗七个月。她被诊断为甲氨蝶呤诱发的肺炎，并接受了大剂量治疗性皮质类固醇，但胸部X光检查结果却恶化了。她的痰液核酸扩增试验显示结核分枝杆菌复合群呈阳性，她被诊断为粟粒性肺结核。她接受了异烟肼、利福平、乙胺丁醇和吡嗪酰胺治疗，对治疗显示出良好的临床反应。当开具英夫利昔单抗时，我们必须牢记可能出现的结核病并发症。
