Madan Karan, Singh Navneet, Das Ashim, Behera Digambar
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
BMJ Case Rep. 2013 Jan 22;2013:bcr2012008196. doi: 10.1136/bcr-2012-008196.
Malignancy per se and cytotoxic chemotherapy given for its treatment both are recognised risk factors for the development of tuberculosis (TB). However, individual case descriptions of pleural tuberculosis (TB-PE) following chemotherapy for lung cancer (LC) have not been published previously. We herein report the first two cases of histopathologically proven TB-PE following LC chemotherapy. The first patient was a 38-year-old man with stage IV non-small cell LC (adenocarcinoma) who developed TB-PE following four cycles of chemotherapy (pemetrexed-cisplatin). The second patient was a 49-year-old man with extensive disease small cell LC who developed TB-PE after six cycles of chemotherapy (irinotecan-cisplatin). In both patients, diagnosis of TB-PE was established by demonstration of granulomatous inflammation, caseous necrosis and positive stain for acid-fast bacilli in pleural biopsy specimens. Both cases responded to standard four-drug antitubercular therapy. These cases highlight the importance of carrying out an extensive evaluation for exudative pleural effusions in LC patients receiving chemotherapy, especially in countries with high TB prevalence. Attributing such pleural effusions to disease progression, without histopathological confirmation, may be associated with disastrous consequences.
恶性肿瘤本身及其治疗所用的细胞毒性化疗均被认为是结核病（TB）发生的危险因素。然而，此前尚未发表过肺癌（LC）化疗后发生胸膜结核（TB-PE）的个案描述。我们在此报告首例经组织病理学证实的LC化疗后发生TB-PE的两例病例。首例患者为一名38岁男性，患有IV期非小细胞LC（腺癌），在接受四个周期化疗（培美曲塞-顺铂）后发生TB-PE。第二例患者为一名49岁男性，患有广泛期小细胞LC，在接受六个周期化疗（伊立替康-顺铂）后发生TB-PE。在两名患者中，通过胸膜活检标本中显示肉芽肿性炎症、干酪样坏死以及抗酸杆菌染色阳性确诊为TB-PE。两例病例对标准四联抗结核治疗均有反应。这些病例凸显了对接受化疗的LC患者的渗出性胸腔积液进行广泛评估的重要性，尤其是在结核病高流行国家。在没有组织病理学证实的情况下，将此类胸腔积液归因于疾病进展可能会带来灾难性后果。
