Amano Hiroyuki, Takamori Mikio, Fujita Akira, Sakashita Kentarou, Murata Kengo, Miyamoto Maki, Wada Akihiko
Department of Pulmonary Medicine, Tokyo Metropolitan Fuchu Hospital, Tokyo, Japan.
Kekkaku. 2009 Aug;84(8):591-5.
A 79-year-old man was admitted to a previous hospital complaining of left precordial swelling. Chest CT scan showed destruction of left sternoclavicular joint and a mass of 5 cm in diameter. Needle biopsy was performed and the diagnosis of sternoclavicular joint tuberculosis was made on the basis of presence of M. tuberculosis in the specimen. The patient was treated with isoniazid, ethambutol, rifampicin, and pyrazinamid but he developed renal failure. Then, he was transferred to our hospital. All medications were suspended because of the possibility of the side effect of drugs. We performed renal biopsy and histopathological examination revealed interstitial nephritis and minimal-change glomerulonephritis. From the result of examination, we considered interstitial nephritis was due to rifamicin. The treatment with 50 mg/day of prednisolone and isoniazid, ethambutol, and levofloxacin was administrated and renal failure and precordial mass were improved. Tuberculous arthritis usually affect hip and knee joint and sternoclavicular joint involvement is very rare.
一名79岁男性因左胸前区肿胀入住前一家医院。胸部CT扫描显示左胸锁关节破坏，有一个直径5厘米的肿块。进行了针吸活检，根据标本中存在结核分枝杆菌诊断为胸锁关节结核。该患者接受异烟肼、乙胺丁醇、利福平及吡嗪酰胺治疗，但出现了肾衰竭。随后，他被转至我院。由于药物副作用的可能性，所有药物均停用。我们进行了肾活检，组织病理学检查显示为间质性肾炎和微小病变性肾小球肾炎。根据检查结果，我们认为间质性肾炎是由利福霉素引起的。给予泼尼松龙50毫克/天以及异烟肼、乙胺丁醇和左氧氟沙星治疗，肾衰竭和胸前区肿块均得到改善。结核性关节炎通常累及髋关节和膝关节，累及胸锁关节非常罕见。
