Tokunaga N, Ichikawa Y, Kuboshiro M, Higashi T, Fujino K, Kaji M
Fist Department of Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan.
Kekkaku. 1990 Aug;65(8):539-43.
We reported a case of 64 year-old female patient of pulmonary tuberculosis associated with ARDS during corticosteroid treatment of Rheumatoid Arthritis. On admission her chief complaints were fever, fatigue and dyspnea. A chest roentgenogram showed diffuse alveolar infiltration consistent with pulmonary edema. Arterial blood gas studies showed severe hypoxemia. We clinically diagnosed so-called ARDS. Smears of sputum for acid fast bacilli were negative, but transbronchial lung brushing by bronchofiberscope revealed many acid fast bacilli. Intensive therapy with anti-tuberculosis drugs (INH, RFP, SM), high dose corticosteroid (methylprednisolone) therapy and mechanical ventilation was started. During the following 2 weeks, the PaO2 rose gradually and the alveolar infiltration on the chest roentgenogram disappeared. The experience of this case to emphasized the importance of suspecting this condition because pulmonary tuberculosis is a potentially curable cause of ARDS and it should also be emphasized that the good treatment effect could be expected with combined use of high dose corticosteroid and mechanical ventilation.
我们报告了一例64岁女性患者，她在类风湿关节炎的皮质类固醇治疗期间患肺结核并伴有急性呼吸窘迫综合征（ARDS）。入院时，她的主要症状为发热、乏力和呼吸困难。胸部X线片显示弥漫性肺泡浸润，符合肺水肿表现。动脉血气分析显示严重低氧血症。我们临床诊断为所谓的ARDS。痰涂片抗酸杆菌检查为阴性，但经纤维支气管镜进行的经支气管肺刷检发现了许多抗酸杆菌。于是开始采用抗结核药物（异烟肼、利福平、链霉素）强化治疗、大剂量皮质类固醇（甲泼尼龙）治疗以及机械通气。在接下来的2周内，动脉血氧分压（PaO2）逐渐上升，胸部X线片上的肺泡浸润消失。该病例经验强调了怀疑这种情况的重要性，因为肺结核是ARDS的一个潜在可治愈病因，还应强调联合使用大剂量皮质类固醇和机械通气可望取得良好的治疗效果。
