Wakabayashi Kiryo, Yano Shuichi, Kobayashi Kanako, Kadowaki Toru, Kimura Masahiro, Ishikawa Shigenori, Ikeda Toshikazu
Department of Pulmonary Medicine, National Hospital Organization Matsue Medical Center, 5-8-31, Agenogi, Matsue-shi, Shimane 690-8556, Japan.
Kekkaku. 2010 Aug;85(8):679-82.
On December 6, 2008, a 52-year-old man presented to a clinic with chronic cough, sputum, and chest discomfort, which had lasted since mid-November. Since the chest radiograph showed a small cavity with small nodules and granular shadows, he was referred to another hospital. On TB-PCR, the gastric juice was positive. Therefore, on December 16, 2008, treatment for pulmonary tuberculosis was initiated with isoniazid, rifampicin, ethambutol, and pyrazinamide. However, on February 4, 2009, a drug susceptibility test revealed that the bacilli were resistant to isoniazid and rifampicin. Therefore, he was referred to our hospital. At that time, he had no symptoms and his sputum smear was negative. We performed a right upper lobectomy. The smear result of the surgical specimen was heavily positive (equivalent to Gaffky 6), and the drug susceptibility test showed resistance to ethambutol in addition to isoniazid and rifampicin. After surgery, we treated him with pyrazinamide, streptomycin, para-aminosalicylate, ethionamide, and levofloxacin. We report this case of multidrug-resistant tuberculosis without past treatment who acquired additional resistance to ethambutol during the first 2 months of chemotherapy. When treating multidrug-resistant tuberculosis, very careful consideration of susceptibility to other drugs is warranted.
2008年12月6日，一名52岁男性因自11月中旬起持续存在的慢性咳嗽、咳痰及胸部不适前往一家诊所就诊。由于胸部X线片显示有一个伴有小结节和颗粒状阴影的小空洞，他被转诊至另一家医院。结核聚合酶链反应（TB-PCR）检测显示胃液呈阳性。因此，2008年12月16日开始用异烟肼、利福平、乙胺丁醇和吡嗪酰胺进行肺结核治疗。然而，2009年2月4日的药敏试验显示结核杆菌对异烟肼和利福平耐药。因此，他被转诊至我院。当时，他没有症状，痰涂片为阴性。我们为他实施了右上肺叶切除术。手术标本的涂片结果为强阳性（相当于Gaffky 6级），药敏试验显示除异烟肼和利福平外，结核杆菌对乙胺丁醇也耐药。术后，我们用吡嗪酰胺、链霉素、对氨基水杨酸、乙硫异烟胺和左氧氟沙星对他进行治疗。我们报告了这例既往未接受过治疗的耐多药结核病病例，该患者在化疗的前2个月内又获得了对乙胺丁醇的耐药性。在治疗耐多药结核病时，非常有必要仔细考虑对其他药物的敏感性。
