Shimizu Tetsuya, Ujita Masuo, Numata Takanori, Harada Tohru, Kuwano Kazuyoshi, Fukuda Kunihiko
Department of Radiology, the Jikei University School of Medicine.
Nihon Kokyuki Gakkai Zasshi. 2011 Aug;49(8):583-7.
A 70-year-old woman with rheumatoid arthritis received treatment with corticosteroids and methotrexate for 4 years, followed by an additional TNF-alpha antagonist (infliximab) for about 3 years. She presented with a several-week history of persistent cough, and CT images of the lung showed a thin-walled cavitary lesion abutting the pleural surface of the left upper lobe. While we investigated the cause of this lesion, we admitted her because of acute chest pain. Chest radiography demonstrated moderate left-sided pneumothorax with pleural effusion. After further investigation, we suspected that her pneumothorax and pleuritis had been caused by a ruptured cavitary lesion arising from a Mycobacterium avium infection. Despite multi-drug therapy, chest tube drainage and surgical pulmorrhaphy her pleural complications were intractable. This is a rare case of pneumothorax and pleuritis caused by Mycobacterium avium infection induced by a TNF-alpha antagonist. Physicians should be aware of nontuberculous mycobacterial infections in patients treated with TNF-alpha antagonists.
一名70岁的类风湿性关节炎女性接受皮质类固醇和甲氨蝶呤治疗4年，随后又使用肿瘤坏死因子-α拮抗剂（英夫利昔单抗）治疗约3年。她出现了持续数周的咳嗽病史，肺部CT图像显示左肺上叶胸膜表面有一个薄壁空洞性病变。在我们调查该病变的病因时，她因急性胸痛入院。胸部X线检查显示左侧中度气胸伴胸腔积液。进一步检查后，我们怀疑她的气胸和胸膜炎是由鸟分枝杆菌感染引起的空洞性病变破裂所致。尽管进行了多药治疗、胸腔闭式引流和手术肺修补术，她的胸膜并发症仍难以处理。这是一例由肿瘤坏死因子-α拮抗剂诱发的鸟分枝杆菌感染导致气胸和胸膜炎的罕见病例。医生在使用肿瘤坏死因子-α拮抗剂治疗的患者中应警惕非结核分枝杆菌感染。
