Nakazawa Atsuhito, Hagiwara Eri, Ikeda Satoshi, Oda Tsuneyuki, Komatsu Shigeru, Ogura Takashi
Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1, Tomioka-Higashi, Kanazawa-ku, Yokohama-shi, Kanagawa 236-0051 Japan.
Kekkaku. 2012 Nov;87(11):727-31.
In September 2008, a 60-year-old woman presented to our hospital with a complaint of bloody sputum; she was healthy until this event. Chest computed tomography scan revealed a cavity, nodular shadows, and bronchiectasis in the left upper lobe and in the left and right middle lobes. Acid-fast bacilli were detected 2 times on gastric juice culture and Mycobacterium gordonae was identified on biochemical study. No active chemotherapy was administered because the discharge of this strain was considered casual and clinically nonsignificant. However, her radiological findings worsened in the following 1 year and 3 months, and M. gordonae was detected 2 more times on gastric juice culture. Subsequently, she was diagnosed with pulmonary mycobacteriosis caused by M. gordonae and was treated with clarithromycin, rifampicin, and levofloxacin. After 1 month, her gastric juice culture yielded negative results for M. gordonae, and after a year and a half, her radiological findings improved. In this case, gastric juice culture was as useful as sputum examination for diagnosis and evaluation of the disease. Although M. gordonae is usually considered nonpathogenic, our study shows that it can be pathogenic, and M. gordonae infection may require treatment with chemotherapy.
2008年9月,一名60岁女性因咯血痰症状前来我院就诊;在此之前她一直身体健康。胸部计算机断层扫描显示左上叶以及左右中叶有空洞、结节状阴影和支气管扩张。胃液培养2次检测到抗酸杆菌,生化研究鉴定为戈登分枝杆菌。由于该菌株的排出被认为是偶然的且临床意义不大,因此未进行积极的化疗。然而,在接下来的1年零3个月里,她的影像学检查结果恶化,胃液培养又2次检测到戈登分枝杆菌。随后,她被诊断为戈登分枝杆菌引起的肺部分枝杆菌病,并接受了克拉霉素、利福平和左氧氟沙星治疗。1个月后,她的胃液培养结果显示戈登分枝杆菌呈阴性,1年半后,她的影像学检查结果有所改善。在这个病例中,胃液培养在疾病的诊断和评估方面与痰液检查同样有用。虽然戈登分枝杆菌通常被认为是非致病性的,但我们的研究表明它可能具有致病性,戈登分枝杆菌感染可能需要化疗治疗。