Tajiri Takuma, Tate Genshu, Makino Mutsuki, Akita Hidetaka, Omatsu Mutsuko, Enosawa Tetsuji, Hamatani Shigeharu, Masunaga Atsuko, Kunimura Toshiaki, Mitsuya Toshiyuki, Morohoshi Toshio
Department of Diagnostic Pathology, Showa University Fujigaoka Hospital, Kanagawa, Japan.
J Nippon Med Sch. 2011;78(5):305-11. doi: 10.1272/jnms.78.305.
To assist physicians, especially young physicians, in identifying tuberculosis (TB) infection before the terminal stage, we analyzed 7 cases of numerous tuberculous granulomas in multiple organs and compared clinical and autopsy findings between cases. Patients ranged in age from 41 to 86 years at the time of death. The main chief complaint was fever of unknown origin (3 of 7 cases [43%]). The main underlying conditions were liver cirrhosis (2 of 7 cases [29%]) and chronic renal failure (2 of 7 cases [29%]). Two patients (29%) had been given methylprednisolone pulse therapy for various lung disorders. Active TB was not diagnosed before autopsy in 4 of 7 (57%) patients. Calcified lesions indicative of old TB were present in 4 of 7 (57%) patients. Thus, miliary tuberculosis may represent a re-emergence of latent TB infection in these cases. Various histologic features of nonreactive exudative inflammation were seen, along with granulomas containing Langhans giant cells with or without caseous necrosis in hypervascular organs, such as the lung, liver, and bone marrow. Physicians should be mindful of the possibility of miliary TB when older patients with hepatorenal disease and a history of TB infection have undergone immunosuppressive treatment. Active tuberculous infection can depend on the presence of an underlying disease and immunocompromise.
为帮助医生，尤其是年轻医生在结核病（TB）晚期之前识别TB感染，我们分析了7例多器官出现大量结核性肉芽肿的病例，并比较了各病例的临床和尸检结果。患者死亡时年龄在41至86岁之间。主要主诉为不明原因发热（7例中有3例[43%]）。主要基础疾病为肝硬化（7例中有2例[29%]）和慢性肾衰竭（7例中有2例[29%]）。2例患者（29%）因各种肺部疾病接受过甲泼尼龙冲击治疗。7例患者中有4例（57%）在尸检前未诊断出活动性TB。7例患者中有4例（57%）存在提示陈旧性TB的钙化灶。因此，在这些病例中粟粒性结核可能代表潜伏性TB感染的再发。在肺、肝和骨髓等高血管器官中，可见各种无反应性渗出性炎症的组织学特征，以及含有朗汉斯巨细胞且有或无干酪样坏死的肉芽肿。当患有肝肾疾病且有TB感染史的老年患者接受免疫抑制治疗时，医生应注意粟粒性TB的可能性。活动性结核感染可能取决于基础疾病的存在和免疫功能低下。
